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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503907281
Report Date: 11/08/2023
Date Signed: 11/20/2023 03:11:12 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 CAREFACILITY NUMBER:
503907281
ADMINISTRATOR:FLETCHER, DONNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 578-5531
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
11/08/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
09:13 AM
MET WITH:TIME COMPLETED:
09:30 AM
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On 11/08/2023 Licensing Program Analyst (LPA) Anita Tristan received a call from Licensee, Donna Fletcher stating that she was ill and in the hospital. Licensee stated that she had her signed Inactive Status formed signed and that she would have someone leave it under a planted pot at her front door for me to pick up.

When LPA arrived at the FCCH and retrieved the signed form, LPA rang door bell there was no answer.
SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Anita Tristan
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2023
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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