Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103909306
Report Date: 07/13/2017
Date Signed 07/13/2017 11:01:15 AM

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:BURCHELL, JULIE FAMILY CHILD CAREFACILITY NUMBER:
103909306
ADMINISTRATOR:BURCHELL, JULIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 486-9031
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY:14CENSUS: 8DATE:
07/13/2017
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Dave BurchellTIME COMPLETED:
12:00 PM
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Case Management Inspection today to confirm removal of Kayleen Ybarra. Kayleen failed to receive an exemption from the Caregiver Background Check Bureau. David Burchell confirmed that Kayleen is not present and has never worked at their facility due to the lack of criminal background clearance. David confirmed that the CBCB-9 Letter was received at the facility. Exit interview was conducted with David Burchell.

No deficiencies cited at this visit.
SUPERVISOR'S NAME: Valarie ReedTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Rusty WilsonTELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2017
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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