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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153911614
Report Date: 10/18/2022
Date Signed: 10/18/2022 10:48:17 AM

Document Has Been Signed on 10/18/2022 10:48 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:
10/18/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Deborah CooksTIME COMPLETED:
11:00 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 adult #1 does not resided in the home and intends to submit an exemption request for adult #1. Licensee understands adult #1 is not allowed to reside in the home and/or be present in the licensed facility.

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.

Based on the evidence obtained during today's inspection, the LPA has verified the individual is not present, employed, or residing at the facility.

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.

Verification of removal is complete.
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Diane Mercado
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2022
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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