Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203806650
Report Date: 06/08/2016
Date Signed 06/08/2016 01:49:26 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:URIBE, EVA FAMILY CHILD CAREFACILITY NUMBER:
203806650
ADMINISTRATOR:URIBE, EVAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 664-0747
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY:14CENSUS: 6DATE:
06/08/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Eva UribeTIME COMPLETED:
04:00 PM
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(1) An unannounced annual/random visit is made today by Licensing Program Analyst Rusty Wilson. Met with Licensee Eva Uribe.. A tour of the home, inside and outside, as shown on the facility sketch is provided. Licensee has one small dog with access to children. There is no swimming pool or other bodies of water. No firearms in this home. Poisons, cleaning compounds, medications and other hazardous items are inaccessible to children. There is no fireplace. There is a working fire extinguisher, a smoke detector and carbon monoxide detector. There is adequate heating and ventilation for safety and comfort. There is a working telephone. Adequate supervision is being provided during this visit. Children are supervised when outside in the play area. Capacity as specified on the license is being maintained. Licensee has a current roster of the children. Fire drills are conducted and documented with the date and time every six months. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. CPR/First Aid cards are current. Licensee is not dispensing any medications for children. During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address. Exit interview conducted with Licensee Eva Uribe.
Per Title 22, Division 12, of the California Code of Regulations, no deficiencies observed at this visit.
SUPERVISOR'S NAME: Valarie ReedTELEPHONE: (559) 243-8093
LICENSING EVALUATOR NAME: Rusty WilsonTELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2016
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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