Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503909382
Report Date: 12/20/2016
Date Signed 12/20/2016 10:58:57 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:HINTON, VERA FAMILY CHILD CAREFACILITY NUMBER:
503909382
ADMINISTRATOR:HINTON, VERAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 284-7440
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY:14CENSUS: 6DATE:
12/20/2016
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Vera HintonTIME COMPLETED:
11:30 AM
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LPA Claudia Henley conducted a case management visit today due to an incident which occurred on 11/15/16. LPA was met by licensee Ms. Hinton. There were six day care children present. Interviewed with licensee regarding the incident. Licensee stated she currently is still providing day care for Child #1 and that she has enforced new policies/procedures with the parent of this child to prevent this incident from happening again in the future.

No deficiencies noted. Site visit notice posted. Exit interview was conducted.

BASED UPON INFORMATION THAT WAS OBTAINED FROM THE LICENSEE OR FACILITY STAFF, IT IS DETERMINED THAT THERE WERE NO VIOLATIONS OF CCL REGULATIONS. NO FURTHER ACTION IS REQUIRED AT THIS TIME.
SUPERVISOR'S NAME: Valarie ReedTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Claudia HenleyTELEPHONE: (559) 341-5776
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2016
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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