Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153906054
Report Date: 07/28/2016
Date Signed 07/28/2016 01:07:12 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:PLUMLEY, TERESA FAMILY CHILD CAREFACILITY NUMBER:
153906054
ADMINISTRATOR:PLUMLEY, TERESAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 663-0175
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:14CENSUS: 8DATE:
07/28/2016
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Teresa Plumley, LicenseeTIME COMPLETED:
01:15 PM
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LPA Pete Espinoza conducted Plan of Correction visit today. LPA met with Teresa Plumley, Licensee. Present in the home today were Licensee, her husband and 8 children.

Purpose of the visit is to review children's files per deficiency cited on 06/22/2016. LPA observed and verified completed Consent for Emergency Treatment (LIC627) in all children's files.

Licensee stated she will NOT provide Incidental Medical Services to children in care. Licensee stated she understood she could NOT enroll children in need of Incidental Medical Services prior to sending a Plan for Providing Incidental Medical Services to the Fresno Regional Office.

During visit LPA provided Cleared POC Letter. Exit interview conducted with Teresa Plumley, Licensee.

Per California Code of Regulations Title 22, Division 12, no deficiency was cited during today's visit.

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.

A Notice of Site Visit was posted on parent board.

To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 243-4588
LICENSING EVALUATOR NAME: Peter EspinozaTELEPHONE: 661-644-8231
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2016
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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