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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100405094
Report Date: 06/19/2019
Date Signed: 06/19/2019 01:21:29 PM

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:FIRST CHURCH OF GOD EARLY ENRICHMENT CENTERFACILITY NUMBER:
100405094
ADMINISTRATOR:ANTARAMIAN, LISAFACILITY TYPE:
830
ADDRESS:3920 N. FIRST STREETTELEPHONE:
(559) 227-3222
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY:20CENSUS: 3DATE:
06/19/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Lisa AntaramianTIME COMPLETED:
01:30 PM
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An announced Case Management inspection was made at this Preschool Child Care Center by LPA Patricia Musso today.

This case management inspection was made to obtain signatures for a past visit due to LPA Musso's equipment failure during that inspection.

Today, LPA obtained signatures as needed..

No deficiencies cited during today.

During exit interview LPA viewed the provided LIC9213 being posted and gave instructions that it needs to be posted for 30 days.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Patricia MussoTELEPHONE: (559) 341-5422
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2019
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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