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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243911320
Report Date: 09/30/2021
Date Signed: 09/30/2021 01:52:19 PM

Document Has Been Signed on 09/30/2021 01:52 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:SUKENIK, NAOMI FAMILY CHILD CAREFACILITY NUMBER:
243911320
ADMINISTRATOR:SUKENIK, NAOMIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(217) 607-4902
CITY:MERCEDSTATE: CAZIP CODE:
95340
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
09/30/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Naomi Sukenik - LicenseeTIME COMPLETED:
02:00 PM
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An unannounced Case Management inspection was conducted 9/30/21 by Licensing Program Analyst (LPA) Joseph Pacheco. LPA met with Licensee Naomi Sukenik. Six day-care children were present on this date.

LPA conducted an unannounced Post Licensing inspection on 9/29/21, however, due to computer issues, LPA was unable to provide Licensee with a copy of the LIC809 and Notice Of Site Visit forms associated to the inspection. On this date, LPA obtained pertinent signatures from Licensee and provided Licensee with copies of the aforementioned documents.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, no deficiencies were cited during today's inspection.

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: 09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2021
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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