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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203908693
Report Date: 12/14/2021
Date Signed: 12/14/2021 09:30:43 AM

Document Has Been Signed on 12/14/2021 09:30 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:CALDERON, MARGARITA FAMILY CHILD CAREFACILITY NUMBER:
203908693
ADMINISTRATOR:CALDERON, MARGARITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 718-5750
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
12/14/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Margarita CalderonTIME COMPLETED:
09:45 AM
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On December 14, 2021, Licensing Program Analysts (LPAs) Brannon and Ocegueda conducted a case management inspection. Upon arriving at the facility, licensee, Margarita Calderon, informed LPAs that she is not providing child care services at this time. During today's visit, LPA Ocegueda provided Spanish translation services. Licensee has decided to go on an extended vacation and did not notify the Department. During today's inspection, LPA reviewed inactive status with licensee. LPA provided the Request for Inactive Child Care License Status form. Licensee has decided to go inactive status.

The inactive status conditions were reviewed with licensee.

Per California Code of Regulations Title 22, Division 12, no deficiency cited during today's inspection. Exit interview conducted with licensee, Margarita Calderon. A copy of this report needs to be placed in facility file for public review. A Notice of Site Visit was posted on parent board for 30 days.
SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Cynthia Brannon
LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2021
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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