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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208901
Report Date: 03/21/2025
Date Signed: 03/21/2025 09:41:10 AM

Document Has Been Signed on 03/21/2025 09:41 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:KAREN'S HOUSEFACILITY NUMBER:
107208901
ADMINISTRATOR/
DIRECTOR:		JACOBS, TEMIKA TRINAFACILITY TYPE:
735
ADDRESS:4744 W MENLO AVETELEPHONE:
(559) 275-3277
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY: 4TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
03/21/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Temika "Kym" Jacobs.TIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Katie Brown arrived at the facility to conduct a Case Management Visit. LPA met with Temika "Kym" Jacobs.

During this visit, LPA amended complaint reports on complaint Control Number: 24-AS-20241209114259

Copies of the amended reports as well as this report were signed and provided to AD.
Sergiy PidgirnyTELEPHONE: (559) 246-0610
Katie BrownTELEPHONE: (559) 498-9964
DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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