Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503908818
Report Date: 11/08/2017
Date Signed 11/08/2017 02:33:23 PM

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:PERSHALL, MELISSA FAMILY CHILD CAREFACILITY NUMBER:
503908818
ADMINISTRATOR:PERSHALL, MELISSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 869-5900
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:14CENSUS: 11DATE:
11/08/2017
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Melissa PershallTIME COMPLETED:
02:40 PM
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Licensing Program Analyst Alice Juarez made a Plan Of Correction Inspection to facility. Met with licensee, Melissa Pershall facility was cited on 10/10/2017 - Licensee failed to associate individual to the facility. Prior to employment or initial presence in the child care home, all employees and volunteers subject to a criminal record review shall: Request and be approved for a transfer of a criminal record. Although licensee had proof that employee was fingerprint cleared and associated to another facility, the transfer request was delayed because the LIC508 for being returned and requesting more information, the individual was actually associated on 10/06/2017. Letter of Deficiency Citation Cleared left with licensee on this date.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations , no deficiency cited..
THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS


SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Alice JuarezTELEPHONE: (559) 341-5280
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2017
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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