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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100406616
Report Date: 10/28/2022
Date Signed: 11/01/2022 09:53:02 AM

Document Has Been Signed on 11/01/2022 09:53 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:CHILDTIME CHILDREN'S CENTER (FRESNO)FACILITY NUMBER:
100406616
ADMINISTRATOR:SCHWAB, STEPHANIEFACILITY TYPE:
850
ADDRESS:214 N. CLARKTELEPHONE:
(559) 445-0216
CITY:FRESNOSTATE: CAZIP CODE:
93701
CAPACITY: 74TOTAL ENROLLED CHILDREN: 74CENSUS: 54DATE:
10/28/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Jessica Higgins TIME COMPLETED:
04:00 PM
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This an amended report created on 10/28/22.

This is a duplicate report created in error.
SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Araceli Gibson
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2022
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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Document Has Been Signed on 11/01/2022 09:54 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 10/31/2022 03:42 PM


Created By: Araceli Gibson On 10/28/2022 at 08:40 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: CHILDTIME CHILDREN'S CENTER (FRESNO)
FACILITY NUMBER: 100406616

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/01/2022
Section Cited

101700.3

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Juvenal Moctezuma
LICENSING EVALUATOR NAME:Araceli Gibson
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2022


LIC809 (FAS) - (06/04)
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