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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153911693
Report Date: 04/14/2023
Date Signed: 04/14/2023 10:33:46 AM

Document Has Been Signed on 04/14/2023 10:33 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:MUNOZ, ANASTACIA FAMILY CHILD CAREFACILITY NUMBER:
153911693
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
04/14/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Anastacia Munoz -Licensee TIME COMPLETED:
10:40 AM
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On 4/14/2023, an unannounced Case Management - Plan of Correction (POC) Inspection was conducted by Licensing Program Analyst (LPA) Jessika Thompson. LPA met with Licensee Anastacia Munoz to discuss the POC associated to the deficiency cited on 04/06/2023. Today, LPA observed the day-care room and a bathroom to be clean, orderly, and free of hazards.

LPA provided the licensee with a "Letter of Deficiency Citations Cleared." Letter must be filed in facility for three years and upon request made accessible to the public for review.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations no deficiencies are 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: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/14/2023
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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