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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203809563
Report Date: 05/12/2022
Date Signed: 05/12/2022 03:32:23 PM

Document Has Been Signed on 05/12/2022 03:32 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:MACIAS, MINERVA FAMILY CHILD CAREFACILITY NUMBER:
203809563
ADMINISTRATOR:MACIAS, MINERVAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 871-6138
CITY:MADERASTATE: CAZIP CODE:
93637
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
05/12/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Minerva MaciasTIME COMPLETED:
03:45 PM
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On 05/12/22, Licensing Program Analysts (LPAs) Angelica Slaughter and Stephanie Vega-Gonzalez arrived at facility to conduct an unannounced annual inspection. LPAs met with licensee Minerva Macias. Licensee requested to place her license on inactive status. A Request for Inactive Child Care License Status (LIC 9211) was completed during this visit. Licensee will be on inactive status from 05/01/22 through 04/30/23. Licensee has been instructed to follow the conditions listed on the inactive form. Licensee understands that if she wishes to become active prior to 04/30/23, she is advised to contact Community Care Licensing immediately.
SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Angelica Slaughter
LICENSING EVALUATOR SIGNATURE: DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2022
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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