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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243911534
Report Date: 11/30/2022
Date Signed: 11/30/2022 10:37:43 AM

Document Has Been Signed on 11/30/2022 10:37 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-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:LOPEZ PEREZ, MONICA FAMILY CHILD CAREFACILITY NUMBER:
243911534
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
11/30/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Monica Lopez Perez TIME COMPLETED:
10:30 AM
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On 11/30/22 Licensing Program Analyst (LPA) Araceli Gibson conducted an unannounced case management inspection. LPA met with Spanish speaking Licensee, Monica Lopez Perez. LPA Gibson for the purpose of amending a report. dated on 10/20/22 and to obtain licensee's signature. Amended report is for removal of personal information. LPA obtained original report from licensee.
SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Araceli Gibson
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2022
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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