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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 500309970
Report Date: 01/30/2023
Date Signed: 01/30/2023 11:37:00 AM

Document Has Been Signed on 01/30/2023 11:37 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-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:YAMAMOTO, KIYO FAMILY CHILD CAREFACILITY NUMBER:
500309970
ADMINISTRATOR:YAMAMOTO, KIYOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 324-7281
CITY:NEWMANSTATE: CAZIP CODE:
95360
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
01/30/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Kiyo YamamotoTIME COMPLETED:
11:45 AM
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On 01/30/2023 Licensing Program Analyst (LPA) Daniel Alvarez, conducted an unannounced Case Management Inspection and was met by Licensee Kiyo Yamamoto. The initial purpose of today's inspection was to complete an unannounced annual required inspection, however, the licensee indicated that she had closed her day care business, and has not cared for children since back in March of 2020. LPA advise licensee by signing this report today she would be surrendering her license, licensee stated she understood. Licensee understands that after surrendering her license she can only provide exempt care meaning she can only take care of the children from one family and her relatives children. If licensee wishes to care for children in the future, she will have to reapply to our Department.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Daniel Q Alvarez
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2023
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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