<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103808640
Report Date: 01/27/2022
Date Signed: 01/27/2022 11:55:13 AM

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:OUR LADY OF PERPETUAL HELP SCHOOLFACILITY NUMBER:
103808640
ADMINISTRATOR:BOUCHARD, JOANFACILITY TYPE:
850
ADDRESS:836 DEWITT AVENUETELEPHONE:
(559) 299-7504
CITY:CLOVISSTATE: CAZIP CODE:
93612
CAPACITY:26CENSUS: 20DATE:
01/27/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Nara Adjemian and Administrator Patrick Dodd. TIME COMPLETED:
12:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 1/27/2022, Licensing Program Analyst (LPA) Ocegueda completed an unannounced case management inspection at the facility. LPA met with Administrator Patrick Dodd and Director Nara Adjemian. LPA toured the facility and took a census.

During file review of staff #1's file, it was determined that the staff did not have the proper Department of Social Services criminal record clearance. Facility Administrator was able to show proof that the staff did go through the clearance through their employer (The Dioses of Fresno), but not through the Department of Social Services. Today Mr. Dodd provided an official letter from their employer (The Dioses of Fresno) indicating that staff #1 did receive a Department Of Justice (DOJ) clearance and a Federal Bureau of Investigations (FBI) clearance, however did not receive a Child Abuse Central Index (CACI) clearance.

LPA explained to Mr. Dodd that staff #1 was not properly cleared through the Department and discussed the proper live scan form that should be used.

Today, staff #1 was removed from the preschool classroom and was replaced by a staff (staff #2) that was verified to have a Department approved criminal record clearance.

Per Chapter 1, Division 12, Title 22 of the California Code of Regulations, the following deficiencies are found: (see LIC809-D). A civil penalty of 100.00 dollars was assessed today. Site Visit Notice posted on the parent board.
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ruby OceguedaTELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: OUR LADY OF PERPETUAL HELP SCHOOL
FACILITY NUMBER: 103808640
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/27/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/28/2022
Section Cited

1
2
3
4
5
6
7
CRIMINAL RECORD CLEARANCE: Section 101170(e)(1) & H&S 1596.871- Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review shall obtain a clearance or criminal record exemption. This requirement was not met as evidenced by: record review and interview.
8
9
10
11
12
13
14
Staff #1 obtained criminal record clearance through his/her employer but not the Department of Social Services. According to records review, staff #1 does not have a CACI clearance. Administrator confirmed this information. A civil penalty of 100.00 was assessed today.
8
9
10
11
12
13
14
Proof of stamped Live Scan form will be provided by POC date: 1/28/2022. Deficiency will be cleared upon staff #1 obtaining all proper clearances (DOJ, FBI and CACI) and providing proof to the Department.

1
2
3
4
5
6
7

1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ruby OceguedaTELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:
DATE: 01/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/27/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: OUR LADY OF PERPETUAL HELP SCHOOL
FACILITY NUMBER: 103808640
VISIT DATE: 01/27/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Upon receipt of a Type A violation, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. A copy of the Fact Sheet - Child Care Parent Notification Requirements and a copy of LIC 9224 was given to licensee,

Licensee was provided a copy of appeal rights.

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.

SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ruby OceguedaTELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2022
LIC809 (FAS) - (06/04)
Page: 1 of 1