Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543907943
Report Date: 04/13/2017
Date Signed 04/13/2017 10:34:27 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:VAZQUEZ, OLGA & JORGE FAMILY CHILD CAREFACILITY NUMBER:
543907943
ADMINISTRATOR:VAZQUEZ, OLGA & JORGEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 740-9608
CITY:FARMERSVILLESTATE: CAZIP CODE:
93223
CAPACITY:14CENSUS: 0DATE:
04/13/2017
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Olga VazquezTIME COMPLETED:
11:00 AM
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Licensing Program Analysts (LPAs) Robert Gutierrez and Arnold Cortez conducted a plan of correction (POC) visit in regards to multiple deficiencies cited on March 16th. The corrections observed during todays visit include the fence hole being repaired, a gate latch on the side gate, and shot records. The licensee has corrected all deficiencies except anchoring the swing set to the ground. Licensee still has one more day to complete this POC and stated she will send photos of the swing set anchored to the ground


No deficiencies were cited at this time.


LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Rebecca VarelaTELEPHONE: (559) 243-8106
LICENSING EVALUATOR NAME: Robert GutierrezTELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2017
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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