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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543911006
Report Date: 08/03/2022
Date Signed: 08/03/2022 01:31:42 PM

Document Has Been Signed on 08/03/2022 01:31 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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:MONDRAGON, BERENICE FAMILY CHILD CAREFACILITY NUMBER:
543911006
ADMINISTRATOR:MONDRAGON, BERENICEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 318-4378
CITY:TULARESTATE: CAZIP CODE:
93274
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
08/03/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Berenice MondragonTIME COMPLETED:
01:45 PM
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On 08/03/2022 Licensing Program Analyst (LPA) Nancy Her, conducted an unannounced Case Management Inspection and was met by Licensee, Berenice Mondragon. The initial purpose of today's inspection was to complete an annual random inspection, however, the licensee indicated that she has not taken care of more than one child for several months and has decided to surrender her license and terminate her day care business. The licensee surrendered her license and completed a statement indicating her wish to close her facility effective today. 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.

Exit interview conducted and report was reviewed with the facility representative Berenice Mondragon
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Nancy Her
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2022
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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