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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
153910579
Report Date:
07/12/2022
Date Signed:
07/12/2022 01:48:43 PM
Document Has Been Signed on
07/12/2022 01:48 PM
- 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
,
1310 E. SHAW AVE,
FRESNO
,
CA
93710
FACILITY NAME:
HERNANDEZ, MAYRA FAMILY CHILD CARE
FACILITY NUMBER:
153910579
ADMINISTRATOR:
HERNANDEZ, MAYRA
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(661) 375-4093
CITY:
MCFARLAND
STATE:
CA
ZIP CODE:
93250
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
14
CENSUS:
7
DATE:
07/12/2022
TYPE OF VISIT:
Case Management - Annual Continuation
UNANNOUNCED
TIME BEGAN:
01:45 PM
MET WITH:
Mayra Hernandez
TIME COMPLETED:
01:46 PM
NARRATIVE
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LPA failed to save original Inspection Tool on Annual Required LIC 809.
This was a continued 809 Case Management to finalize Annual Inspection.
SUPERVISORS NAME
:
Duane Matsubara
LICENSING EVALUATOR NAME
:
Jose Penate
LICENSING EVALUATOR SIGNATURE
:
DATE:
07/12/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/12/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
3
of
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