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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
503907281
Report Date:
11/07/2023
Date Signed:
11/20/2023 03:11:38 PM
Document Has Been Signed on
11/20/2023 03:11 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-CC
,
1310 E. SHAW AVE,
FRESNO
,
CA
93710
FACILITY NAME:
FLETCHER, DONNA FAMILY CHILD CARE
FACILITY NUMBER:
503907281
ADMINISTRATOR:
FLETCHER, DONNA
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(209) 578-5531
CITY:
MODESTO
STATE:
CA
ZIP CODE:
95356
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
14
CENSUS:
0
DATE:
11/07/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
01:30 PM
MET WITH:
Donna Fletcher
TIME COMPLETED:
02:00 PM
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On 11/8/2023 Licensing Program Analysts (LPAs) Anita Tristan and Stephanie Vega-Gonzalez attempted to conducted an unannounced case management visit to obtain the signed inactive status paperwork request. Licensee was not home. LPA Tristan placed call you licensee informing her that if we do not received the signed paperwork she will remain open and an annual review will need to be conducted.
SUPERVISORS NAME
:
Cynthia Brannon
LICENSING EVALUATOR NAME
:
Anita Tristan
LICENSING EVALUATOR SIGNATURE
:
DATE:
11/08/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/08/2023
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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