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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100407043
Report Date: 05/23/2022
Date Signed: 05/23/2022 10:25:54 AM


Document Has Been Signed on 05/23/2022 10:25 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:JEFFERSON PRESCHOOLFACILITY NUMBER:
100407043
ADMINISTRATOR:LORI WELCHFACILITY TYPE:
850
ADDRESS:1110 TUCKER AVETELEPHONE:
(559) 524-6290
CITY:SANGERSTATE: CAZIP CODE:
93657
CAPACITY:30CENSUS: 11DATE:
05/23/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Sandra OlivoTIME COMPLETED:
10:40 AM
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On 5/23/22 Licensing Program Analyst (LPA) Caroline Harris conducted a Plan of Correction inspection. LPA met with Sandra Olivo. A census was taken. The purpose of todays inspection was to clear deficiencies cited on 4/28/22. LPA reviewed children's files and observed copies of updated immunization records, that were transcribed onto blue cards, in each of the children's files. Staff files also showed proof of all staff completing the Mandated Reporter training and the Criminal Record Statement. All staff also completed the "Supervising Children in Child Care Centers" and a sign in sheet was available for review.

During today’s inspection, LPA provided a Letter of Deficiency Citations Cleared. Exit interview was conducted with Sandra Olivo. Per Chapter 1, Division 12, Title 22 of the California Code of Regulations, no deficiency was cited during today’s inspection.

A copy of this report and LIC 9213 Notice of Site Inspection were provided to the licensee Sandra Olivo. This report shall be made available to the public upon request. LIC 9213 Notice of Site Inspection is required to be posted for 30 days.

To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISOR'S NAME: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Caroline HarrisTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2022
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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