Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153902874
Report Date: 06/22/2015 12:00:00 AM
Date Signed 06/22/2015 12:33:20 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:SHELL, LETICIA FAMILY CHILD CAREFACILITY NUMBER:
153902874
ADMINISTRATOR:SHELL, LETICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 325-6488
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93304
CAPACITY:14CENSUS: 8DATE:
06/22/2015
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Leticia ShellTIME COMPLETED:
12:45 PM
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A case management visit is conducted this date by Licensing Program Analyst Gloria Reyes. Met with licensee, Leticia Shell who is caring for 8 children.

The purpose of today's visit is to interview a day-care child for matters unrelated to this facility.


Exit interview conducted with licensee, Leticia Shell.



No deficiency cited during today's visit.
Notice of Site Visit Form posted to parents board.
SUPERVISOR'S NAME: Rebecca VarelaTELEPHONE: (559) 243-8106
LICENSING EVALUATOR NAME: Gloria ReyesTELEPHONE: (559) 341-4471
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2015
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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