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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243808251
Report Date: 03/03/2023
Date Signed: 03/03/2023 12:53:53 PM

Document Has Been Signed on 03/03/2023 12:53 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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:SAN LUIS HEAD STARTFACILITY NUMBER:
243808251
ADMINISTRATOR:FLORES, MELANIEFACILITY TYPE:
850
ADDRESS:129 7TH STREETTELEPHONE:
(209) 827-5691
CITY:LOS BANOSSTATE: CAZIP CODE:
93635
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 0DATE:
03/03/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Misty MendozaTIME COMPLETED:
01:00 PM
NARRATIVE
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On 03/03/23, Licensing Program Analysts (LPAs) Martha De Haro and Yesenia Fierro as well as Licensing Program Manager (LPM) Rene Mancinas conducted an unannounced case management inspection. LPAs and LPM toured the facility and a census was taken. LPAs met with Site Supervisor, Misty Mendoza . The purpose of today's inspection was to follow up an incident regarding practices and policies involving children's privacy. This incident was reported to the Fresno Community Care Licensing Office on 01/25/23.

LPAs and LPM reviewed pertinent documentation at the facility. LPAs and LPM interviewed staff and reviewed restroom supervision/privacy polices at the facility. Information obtained revealed facility implements proper policies and procedures pertaining to supervision and children's privacy.



Per California Code of Regulations Title 22, Division 12, Chapter 1 no deficiency cited during today's visit. Exit interview conducted with Site Supervisor, Misty Mendoza.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Rene Mancinas
LICENSING EVALUATOR NAME: Martha DeHaro
LICENSING EVALUATOR SIGNATURE: DATE: 03/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2023
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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