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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153908797
Report Date: 11/06/2023
Date Signed: 11/06/2023 08:59:23 AM

Document Has Been Signed on 11/06/2023 08:59 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 SOUTH CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:JIMENEZ, ELBA FAMILY CHILD CAREFACILITY NUMBER:
153908797
ADMINISTRATOR:JIMENEZ, ELBAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 720-9580
CITY:DELANOSTATE: CAZIP CODE:
93215
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
11/06/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Elba JimenzTIME COMPLETED:
09:15 AM
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On 11/06/2023, Licensing Program Analyst (LPA) Gloria Reyes conducted a Case Management inspection - Licensee Initiated. LPA was met by Licensee, Elba Jimenez who is caring for one child. Licensee is Spanish speaking.

The purpose of today's inspection is to inspect the room addition to the home that will be accessible to day care children. This room addition has a bathroom, sink and a sliding door that exits to the backyard. The room has heating and ventilation for safety and comfort. The required forms are posted. Fire extinguisher, smoke detector, and carbon monoxide detector are operable and in place.

Licensee provided a copy of the updated Facility Sketch and the City of Delano approval permit for the room addition. LPA reviewed city permit and found the room addition to be safe for day care children use.


Per California Code of Regulations, Title 22, Division 12, Chapter 3, no deficiency cited.

An exit interview conducted with Licensee Elba Jimenez and a copy of this report was provided and discussed. A Notice of Site Visit Form (LIC 9213) was posted on parent's board and must remain posted for 30 days.
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Gloria Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 11/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2023
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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