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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203910423
Report Date: 05/20/2022
Date Signed: 05/20/2022 02:36:30 PM

Document Has Been Signed on 05/20/2022 02:36 PM - 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:SANTOS, ANDREA FAMILY CHILD CAREFACILITY NUMBER:
203910423
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
05/20/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Andrea SantosTIME COMPLETED:
02:45 PM
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On 05/20/22, Licensing Program Analyst (LPA) Angelica Slaughter conducted an unannounced Case Management inspection to the facility. LPA met with Licensee Andrea Santos. A tour of the facility was also conducted and a census taken.

The purpose of this inspection was to confirm that the partially cleared individual that was living in the home has moved out and is no longer residing in the home. LPA conducted an inspection of the entire home, including rooms that are inaccessible to children in care, as well as the garage. LPA did not observe any other items that could potentially belong to the individual who previously occupied the home. The bedroom formerly occupied by the individual was empty of clothing or any personal belongings.

LPA reminded Licensee that prior to working, residing, or volunteering in a licensed facility, all individuals subject to a criminal record review must obtain criminal record clearance. Licensee stated she understands.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, no deficiency was cited today.

A Notice of Site Visit (LIC 9213) was provided to the Licensee and must be posted for 30 days.
SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Angelica Slaughter
LICENSING EVALUATOR SIGNATURE: DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/20/2022
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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