Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203809807
Report Date: 08/22/2018
Date Signed: 08/27/2018 04:17:03 PM

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:GUERRERO - MENDEZ, ARACELI FAMILY CHILD CARE HOMEFACILITY NUMBER:
203809807
ADMINISTRATOR:GUERRERO - MENDEZ, ARACELIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 673-8040
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY:14CENSUS: 2DATE:
08/22/2018
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Araceli Guerrero-MendezTIME COMPLETED:
11:45 AM
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An unannounced case management inspection was made at this Family Child Care Home by LPA Patricia Musso today.

This case management inspection was made to deliver the report of the 8/9/18 Required 3 year inspection, due to LPA's equipment failure during that inspection.

Today LPA delivered the 8/9/18 LIC809 report.


No deficiencies cited today.

During exit interview LPA viewed the provided LIC9213 being posted and gave
instructions that it needs to be posted for 30 days.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Patricia MussoTELEPHONE: (559) 341-5422
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2018
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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