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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153910947
Report Date: 02/23/2023
Date Signed: 02/23/2023 10:42:49 AM

Document Has Been Signed on 02/23/2023 10:42 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
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:TISDALE, CLEOPATRA FAMILY CHILD CAREFACILITY NUMBER:
153910947
ADMINISTRATOR:TISDALE, CLEOPATRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 564-8121
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93313
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
02/23/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Cleopatra Tisdale TIME COMPLETED:
10:45 AM
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On 2/23/23, An unannounced Case Management inspection was conducted by Licensing Program Analyst (LPA ) Jessika Thompson. LPA met with Licensee Cleopatra Tisdale and toured the facility. The purpose of today's inspection was to review and deliver an amended Complaint Evaluation Report (LIC9099). Licensee was advised that the LIC9099, dated 1/12/23, was revised from the purpose of changing the LIC9099, which contains an unsubstantiated allegation, from a confidential report, to a public report (refer to amended LIC9099, dated 1/12/23 for further details). LPA explained finding requirements to Licensee. The report was reviewed with licensee and a signature was obtained.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, no deficiencies were observed today.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Jessika Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2023
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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