Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103909306
Report Date: 05/27/2015 12:00:00 AM
Date Signed 05/27/2015 02:16:18 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 E.SHAW AV,STE 300-MS 29-01
FRESNO, CA 93710
FACILITY NAME:BURCHELL, JULIE FAMILY CHILD CAREFACILITY NUMBER:
103909306
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
05/27/2015
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Ruby PachecoTIME COMPLETED:
09:50 AM
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An unannounced Case Management Visit is being conducted today by Licensing Program Analyst Patricia Musso. Licensee was not at home during this visit. Her assistant Ruby Pacheco was providing care for and supervising to the children

This Case Management visit is being conducted for the assigned LPA, Musso, to introduce herself
to licensee and see if licensee had any questions since being licensed at this home.
Ruby told LPA that licensee was away at an appointment, licensee has 6 children enrolled in this day care at this time, she is one of licensee's assistants and another assistant is Samantha Diaz.

LPA told Ruby that she will return to speak to licensee and answer any questions.

During the exit interview, LPA gave instructions to post LIC9213 for 30 days, which was left with licensee today.

No Title 22 deficiencies are cited during this visit.

Ruby believes the hours of operation are Monday through Friday, 7:30 am to 5:30 pm.
SUPERVISOR'S NAME: Valarie ReedTELEPHONE: (559) 243-8093
LICENSING EVALUATOR NAME: Patricia MussoTELEPHONE: (559) 341-5422
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2015
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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