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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 165620061
Report Date: 05/07/2024
Date Signed: 05/07/2024 02:29:15 PM

Document Has Been Signed on 05/07/2024 02:29 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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:GUTIERREZ, ANA FAMILY CHILD CAREFACILITY NUMBER:
165620061
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
05/07/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:16 PM
MET WITH:Ana GutierrezTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On May 7, 2024, Licensing Program Analyst (LPA) Paul Garcia conducted an unannounced case management inspection. LPA Garcia met with licensee Ana Gutierrez. Upon arrival, a census was taken, and LPA toured the facility inside and outside. This visit was initiated by Ana Gutierrez. The purpose for the visit was to approve or deny the use of a new outdoor play structure located in the backyard play area.

Licensee contacted LPA Garcia on May 3, 2024, telephonically on his state issued cell phone. Ana informed LPA that she has finished with the installation of a new two tear play structure.

LPA inspected the backyard play structure and observed that the recommended age use is for children ages three (3) years old – eleven (11) years of age. Observed were two attached swings, a climbing wall, two separate standing platforms and a swirl enclosed slide. LPA observed areas around high climbing equipment, swings and slides have cushioning material to absorb falls.

LPA APROVES the immediate use of the play structure. LPA obtained a new facility sketch to include the new play structure and new dimensions of the outdoor play area.

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

A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Gloria Reyes
LICENSING EVALUATOR NAME: Paul Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/07/2024
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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