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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 163903825
Report Date: 07/25/2022
Date Signed: 10/18/2022 11:21:16 AM

Document Has Been Signed on 10/18/2022 11:21 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:LUNA, MARIA FAMILY CHILD CAREFACILITY NUMBER:
163903825
ADMINISTRATOR:LUNA, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 386-9894
CITY:AVENALSTATE: CAZIP CODE:
93204
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
07/25/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Maria LunaTIME COMPLETED:
11:25 AM
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This case management report document was created and final printed on 7/25/2022 in error. There was no case management inspection completed at this facility on 7/25/2022. The case management inspection was for a facility in a different location with the same last and first name (Luna, Maria FCC). This document was created in error and the error was discovered by Licensing Program Analyst (LPA) Ocegueda on 10/3/2022 and after consultation was corrected by amending this report on 10/18/2022.

SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2022
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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