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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243911934
Report Date: 01/12/2023
Date Signed: 01/12/2023 10:43:48 AM

Document Has Been Signed on 01/12/2023 10:43 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:GONZALEZ ACOSTA, LUZ FAMILY CHILD CAREFACILITY NUMBER:
243911934
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
01/12/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Luz Acosta GonzalezTIME COMPLETED:
10:45 AM
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On 01/12/2023 a planned second pre-licensing inspection was made today by Licensing Program Analysts (LPAs) Nancy Her and Denisia Jimenez, who met with Applicant, Luz Gonzalez Acosta, who is Spanish speaking. LPA Jimenez provided translation services in Spanish. The purpose for inspection was to verify the following correction was made:

Before Licensure the following item was needing to be corrected:

1. There is a pellet gun with lead pellets located at this home. Applicant stated it would be removed from the home within 30 days. LPA advised firearms and ammunition need to be locked and stored separately as required per regulations.

Above item was corrected and verified during today’s inspection. Pellet gun and lead pellets were removed from the home on 12/28/2022.

This home meets the description of a safe and healthy environment for children as described in Chapter 3, Division 12, Title 22 of California Code of Regulations and licensure for a capacity of up to 8 children. Licensure as a small Family Child Care Home capacity of 8 children* ages under 18 years, will be granted effective 01/13/2023. Hours of operation are Monday from 12:00AM – Friday at 12:00 AM, and as arranged

Exit interview conducted and report was reviewed with the applicant.
This report shall be made available to the public upon request.
To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Nancy Her
LICENSING EVALUATOR SIGNATURE: DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2023
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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