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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543910771
Report Date: 07/02/2021
Date Signed: 07/02/2021 02:16:30 PM

Document Has Been Signed on 07/02/2021 02:16 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:MAGANA, SUSANA FAMILY CHILD CAREFACILITY NUMBER:
543910771
ADMINISTRATOR:MAGANA, SUSANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 300-6859
CITY:TULARESTATE: CAZIP CODE:
93274
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
07/02/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Susana MaganaTIME COMPLETED:
02:30 PM
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Licensing Program Analysts (LPAs) Nancy Her and Daniel Alvarez conducted an unannounced case management inspection due to licensee wanting to add a room to her day-care. LPAs were met by licensee Susana Magana. The purpose of today's inspection was to approve the recent new room addition (bonus room). LPAs observed safe children's toys, books and safe equipment. There is a functioning smoke detector. The room addition is approved for day care use effective 7/02/2021. Licensee submitted a new facility sketch for the accessible areas in her home.

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

A COPY OF THIS REPORT IS TO REMAIN IN THE FACILITY FOR PUBLIC REVIEW.
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: 07/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/02/2021
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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