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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243805494
Report Date: 07/26/2021
Date Signed: 07/26/2021 10:07:57 AM

Document Has Been Signed on 07/26/2021 10:07 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:JEADELINE'SFACILITY NUMBER:
243805494
ADMINISTRATOR:PEREZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 720-9472
CITY:MERCEDSTATE: CAZIP CODE:
95340
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
07/26/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Maria Perez - LicenseeTIME COMPLETED:
10:15 AM
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On 7/26/21 Licensing Program Analysts (LPAs), Joseph Pacheco and Roman Iglesias arrived at the family day care home to conduct an unannounced Case Management - Plan of Correction (POC) Inspection. LPAs met with Licensee Maria Perez to review the POCs associated to deficiency cited on 7/7/21: Today, LPAs verified the following:

ยท Licensee has removed defects or conditions in her backyard that might endanger a child.

LPAs cleared deficiency on this date and provided licensee with a "Letter of Deficiency Citations Cleared." This letter must be filed in the facility for three years and upon request made accessible to the public for review.

No deficiency cited on this date.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Joseph Pacheco
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2021
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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