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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543911532
Report Date: 11/10/2022
Date Signed: 11/10/2022 01:28:10 PM

Document Has Been Signed on 11/10/2022 01:28 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:ALVA, EVANGELINA FAMILY CHILD CAREFACILITY NUMBER:
543911532
ADMINISTRATOR:ALVA, EVANGELINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 940-0501
CITY:TULARESTATE: CAZIP CODE:
93274
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
11/10/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Evangelina AlvaTIME COMPLETED:
01:30 PM
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On 11/10/2022 An unannounced Case Management inspection was conducted by Licensing Program Analyst (LPA) Nancy Her. LPA met with Licensee, Evangelina Alva. 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. Due to having Covid, the licensee stated she will surrender her license and complete a statement indicating her wish to close her facility effective today and mail it in. 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 Evangelina Alva.
A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Nancy Her
LICENSING EVALUATOR SIGNATURE: DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/10/2022
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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