<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153808615
Report Date: 10/07/2021
Date Signed: 10/07/2021 02:04:33 PM

Document Has Been Signed on 10/07/2021 02:04 PM - 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:TIERRA SERENA CHILD DEVELOPMENT CENTERFACILITY NUMBER:
153808615
ADMINISTRATOR:LORENA PALOMOFACILITY TYPE:
850
ADDRESS:17213 CENTRAL VALLEY HWYTELEPHONE:
(661) 746-0671
CITY:SHAFTERSTATE: CAZIP CODE:
93263
CAPACITY: 60TOTAL ENROLLED CHILDREN: 0CENSUS: 18DATE:
10/07/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Dedrelynn CainTIME COMPLETED:
02:10 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 10/07/2021, Licensing Program Analyst (LPA) Jeovanna Yanez conducted by an unannounced Case Management inspection. LPA met with Teacher II Dedrelynn Cain, and toured the facility inside and outside. A census was taken. The purpose of today's inspection was to deliver an amended facility evaluation report (refer to amended facility evaluation report dated 10/1/21 for further details).

Per Chapter 1, Division 12, Title 22 of the California Code of Regulations, no deficiencies were observed today.

An exit interview was conducted with Teacher II Dedrelynn Cain.

A Notice Of Site Visit (LIC9213) form was provided to Teacher II Dedrelynn Cain today. Teacher II Dedrelynn Cainwas advised that the LIC9213 is required to be posted for 30 days.
SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE: DATE: 10/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/07/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1