Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543907943
Report Date: 01/07/2019
Date Signed 01/07/2019 10:52:03 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) 667-5967
CITY:FARMERSVILLESTATE: CAZIP CODE:
93223
CAPACITY:14CENSUS: 8DATE:
01/07/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Olga VazquezTIME COMPLETED:
11:00 AM
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LPA Caroline Harris conducted Plan of Correction visit today. LPA met with Licensee, Olga Vazquez. Also present was her son.

The purpose of todays visit is to observe the back yard side gate per deficiency cited on 12/14/18. LPA observed the gate to be repaired and the latch to be replaced and latching appropriately. The adjacent fence where the gate latches is also secured. The LPA also observed the outside shade covers to be taken down and the licensee stated that they will replace them when the whether changes.

During visit LPA provided Letter of Deficiency Citations Cleared. Exit interview conducted with Olga Vazquez.

Per California Code of Regulations Title 22, Division 12, no deficiency was cited during today's visit.

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
A Notice of Site Visit was posted on parent board.

To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISOR'S NAME: Valarie ReedTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Caroline HarrisTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2019
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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