Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243909084
Report Date: 09/14/2017
Date Signed 09/18/2017 09:06:32 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:JARAMILLO, JACQUELINE FAMILY CHILD CAREFACILITY NUMBER:
243909084
ADMINISTRATOR:JARAMILLO, JACQUELINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 725-9452
CITY:MERCEDSTATE: CAZIP CODE:
95341
CAPACITY:14CENSUS: 0DATE:
09/14/2017
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Licensee, Jacqueline JaramilloTIME COMPLETED:
02:45 PM
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LPA Frances Ortiz conducted a Plan of Correction inspection today. LPA met with licensee, Jacqueline Jaramillo. Tour of home was made and census was taken. LPA observed the completed Medical Consent Form and the Parents Rights Form signed by the parents in the children's files as indicated on Plan of Correction of Facility Evaluation Report (LIC 809) dated 8/10/17.

Per California Code of Regulations Title 22, Division 12, Title 3, there are no deficiencies cited. Exit interview conducted with licensee. Letter of cleared deficiencies was left and shall be posted for 30 days.

NOTICE OF SITE VISIT TO BE POSTED ON PARENT BOARD FOR 30 DAYS.

A COPY OF THIS REPORT IS TO REMAIN IN THE FACILITY FOR PUBLIC REVIEW AND MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Frances OrtizTELEPHONE: (559) 341-5431
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2017
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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