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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153911614
Report Date: 09/07/2022
Date Signed: 09/07/2022 10:14:15 AM

Document Has Been Signed on 09/07/2022 10:14 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:COOKS, DEBORAH FAMILY CHILD CAREFACILITY NUMBER:
153911614
ADMINISTRATOR:COOKS, DEBORAHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 246-8927
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93304
CAPACITY: 14TOTAL ENROLLED CHILDREN: 5CENSUS: 0DATE:
09/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Deborah CooksTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA), Diane Mercado conducted an unannounced case management inspection. LPA met with Licensee, Deborah Cooks. The purpose of this inspection was to conduct a confirmation of removal regarding adult #1. Licensee stated has not received notice of 'Confirmation of Removal' LIC 300A letter in the mail. Licensee did a change of location and has been licensed at current address since September 01,2021.

Adult #1 is observed to be present in the home. There are no day children in care. Licensee agrees and understands adult #1 is not allowed to reside in the home and/or be present in the licensed facility unless an exemption is requested and granted.

Hours of Operation: Monday through Friday; 06:00am-06:00pm.

LPA also provided Licensee with a copy of the Family Child Care Home Addendum to Notification of Parent's Rights (regarding Removal/Exclusion) form LIC 995B.

Per California Code of Regulations Title 22 Division 12 Chapter 3, no deficiency is being cited today. Notice of Site Visit to be posted for 30 days.
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Diane Mercado
LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2022
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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