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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153911355
Report Date: 01/10/2022
Date Signed: 01/10/2022 10:23:46 AM

Document Has Been Signed on 01/10/2022 10:23 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:WILSON, JENNIFER FAMILY CHILD CAREFACILITY NUMBER:
153911355
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
01/10/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Jennifer Wilson TIME COMPLETED:
10:37 AM
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On 01/10/22 Licensing Program Analysts (LPA) Araceli Gibson conducted a Case Management inspection to provide and explain increase in capacity requirements, Licensee had no children in care at the time of the inspection. Licensee will have a year of experience on 01/11/22 of being licensed for a year. LPA explained the process of the fire inspection and fire alarm pull down latch.. LPA explained the licensing paperwork for an assistant/employee.

Per California Code of Regulations Title 22, Division 12, Chapter 1 no deficiency cited during today's visit. Exit interview conducted with the Licensee.



LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
To order forms, etc. visit our website at www.ccld.ca.gov.
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Araceli Gibson
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2022
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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