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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
543911187
Report Date:
03/18/2022
Date Signed:
03/18/2022 03:35:23 PM
Document Has Been Signed on
03/18/2022 03:35 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:
MARTINEZ-LOMELI, ISABEL FAMILY CHILD CARE
FACILITY NUMBER:
543911187
ADMINISTRATOR:
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
CITY:
STATE:
ZIP CODE:
CAPACITY:
8
TOTAL ENROLLED CHILDREN:
8
CENSUS:
1
DATE:
03/18/2022
TYPE OF VISIT:
Case Management - Annual Continuation
UNANNOUNCED
TIME BEGAN:
12:00 PM
MET WITH:
Isabel Martinez-Lomeli
TIME COMPLETED:
02:00 PM
NARRATIVE
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Refer to LIC809 Required 1 year inspection dated 3/18/2022.
This was not a Case Management visit 2nd visit.
SUPERVISORS NAME
:
Susie Fanning
LICENSING EVALUATOR NAME
:
Theresa Marquez
LICENSING EVALUATOR SIGNATURE
:
DATE:
03/18/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
03/18/2022
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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