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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503911553
Report Date: 12/06/2022
Date Signed: 12/06/2022 01:04:45 PM

Document Has Been Signed on 12/06/2022 01:04 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:LOPEZ, KARLA FAMILY CHILD CAREFACILITY NUMBER:
503911553
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
12/06/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Karla LopezTIME COMPLETED:
01:15 PM
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On 12/6/22, Licensing Program Analyst (LPA) Priscilla Zamudio conducted a case management-other inspection and met with Licensee for the purpose of inspecting the backyard. Licensee requested to make the area accessible after having repaired the fence. LPA toured the area, observed the new fence, sturdy play structures and was found to be safe for use. There is also a large trampoline which will not be used during daycare hours, per Licensee.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.
Exit interview conducted and report was reviewed with Licensee Karla Lopez.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Priscilla Zamudio
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2022
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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