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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103801314
Report Date: 05/25/2022
Date Signed: 05/25/2022 09:41:16 AM


Document Has Been Signed on 05/25/2022 09:41 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:RAISIN CITY PRESCHOOLFACILITY NUMBER:
103801314
ADMINISTRATOR:RAMIREZ, BEATRICEFACILITY TYPE:
850
ADDRESS:6425 WEST BOWLES AVENUETELEPHONE:
(559) 233-0128
CITY:RAISIN CITYSTATE: CAZIP CODE:
93652
CAPACITY:26CENSUS: 14DATE:
05/25/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Anita TemoresTIME COMPLETED:
10:00 AM
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On 5/25/22 Licensing Program Analyst (LPA) Caroline Harris conducted a Plan of Correction inspection. LPA met with Anita Temores a census was taken.

The purpose of todays inspection is to review staff and children's files per deficiencies cited on 4/26/22. LPA reviewed staff files and observed copies of immunization records showing required immunizations, Mandated Reporter training's (AB1207), Criminal Record Statements, Employee Rights and all other required documents in each file. Review of the children's files showed all immunizations were transcribed on to blue cards and children's physicals were in each file.

During today’s inspection, LPA provided a Letter of Deficiency Citations Cleared. Exit interview was conducted with Anita Temores. 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 Ms. Temores. 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: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2022
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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