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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503911784
Report Date: 12/04/2023
Date Signed: 12/04/2023 09:20:40 AM

Document Has Been Signed on 12/04/2023 09:20 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:BEITSAYAD, DOMARINA FAMILY CHILD CAREFACILITY NUMBER:
503911784
ADMINISTRATOR:BEITSAYAD, DOMARINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 505-1846
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
12/04/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Domarina Beitsayad TIME COMPLETED:
09:45 AM
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On 12/04/2023 Licensing Program Analyst (LPA) Yesenia Fierro conducted an unannounced Case Management inspection that Licensee initiated. LPA met with Licensee, Domarina Beitsayad and informed her of the reason for the today’s inspection. LPA toured the facility indoors and outdoors and a census was taken. There were zero children in care as Licensee has zero children enrolled.

Licensee Domarina contacted LPA Fierro informing LPA that she would like to make her living room accessible to children. LPA Fierro inspected the living room and observed it to be safe and in operable conditions.

Licensee provided LPA with an updated facility sketch. LPA approved the use of the living room for care.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISORS NAME: Rene Mancinas
LICENSING EVALUATOR NAME: Yesenia Fierro
LICENSING EVALUATOR SIGNATURE: DATE: 12/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2023
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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