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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 223808272
Report Date: 10/27/2021
Date Signed: 10/27/2021 10:35:31 AM

Document Has Been Signed on 10/27/2021 10:35 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:FIRST 5 MARIPOSA COUNTY BUILDING BLOCKS PRESCHOOLFACILITY NUMBER:
223808272
ADMINISTRATOR:SERRATO, SHIRLEYFACILITY TYPE:
850
ADDRESS:2421 HIDALGOTELEPHONE:
(209) 852-9656
CITY:LA GRANGESTATE: CAZIP CODE:
95329
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 8DATE:
10/27/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Shirley Serrato - DirectorTIME COMPLETED:
10:45 AM
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On 10/27/21, Licensing Program Analyst (LPA) Joseph Pacheco conducted an unannounced case management inspection. LPA met with Director, Shirley Serrato to discuss California Department of Public Health (CDPH) guidelines regarding COVID-19 for Child Care facilities. LPA discussed the purpose of the inspection with Licensee and obtained a census. During today’s inspection LPA provided Director with Technical Assistance regarding the use of face coverings for children over the age of two in Child Care facilities.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, no deficiencies are being cited.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.
SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Joseph Pacheco
LICENSING EVALUATOR SIGNATURE: DATE: 10/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2021
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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