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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503909165
Report Date: 10/06/2021
Date Signed: 10/11/2021 11:51:44 AM

Document Has Been Signed on 10/11/2021 11:51 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:CASTRO, STACY FAMILY CHILD CAREFACILITY NUMBER:
503909165
ADMINISTRATOR:CASTRO, STACYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 652-3115
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
10/06/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Licensee, Susana CastroTIME COMPLETED:
01:35 PM
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LPA Galvan arrived at location on file and spoke with Licensee, Susana. Susana stated she informed via text that she was closed effective October 1, 2021 due to retirement.

LPA Galvan did not have this information on her state-issued iPhone due to fact that LPA Galvan recently received a newer model phone and all items did not transfer over successfully.

LPA advised licensee to email LPA Galvan with the information that she is currently retired and not providing child care. Licensee did so, as LPA verified via email the same day.

LIC input sheet was completed and forwarded to clerical staff for processing. End of report.
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Stefanie Galvan
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2021
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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