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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153911178
Report Date: 06/08/2023
Date Signed: 06/08/2023 10:19:14 AM

Document Has Been Signed on 06/08/2023 10:19 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:GUTIERREZ, NORMA FAMILY CHILD CAREFACILITY NUMBER:
153911178
ADMINISTRATOR:GUTIERREZ, NORMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 340-2874
CITY:BAKERFIELDSTATE: CAZIP CODE:
93313
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
06/08/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Norma GutierrezTIME COMPLETED:
10:30 AM
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On 6/08/23, A Case Management inspection was conducted by Licensing Program Analyst (LPA ) Jessika Thompson. LPA met with Licensee Norma Gutierrez and toured the facility. The purpose of today's inspection was to provide the licensee with an updated Civil Penalty Assessment form. Licensee was advised that the completed and signed Civil Penalty Assessment form, dated 5/23/2023, incorrectly reflected a $0.00 penalty amount. A new Civil Penalty Assessment form was created today to reflect an accurate civil penalty assessment of $500.00; this Civil Penalty Assessment form was reviewed, signed, and provided to the licensee today.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, no deficiencies were observed today.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee.
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Jessika Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/08/2023
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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