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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 163801632
Report Date: 04/11/2023
Date Signed: 04/11/2023 01:08:08 PM


Document Has Been Signed on 04/11/2023 01:08 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:HOME GARDEN LEARNING CENTERFACILITY NUMBER:
163801632
ADMINISTRATOR:SIBRIAN, BARBARAFACILITY TYPE:
850
ADDRESS:9726 HOME AVENUETELEPHONE:
(559) 582-7075
CITY:HANFORDSTATE: CAZIP CODE:
93230
CAPACITY:40CENSUS: 23DATE:
04/11/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Shoua MouaTIME COMPLETED:
01:30 PM
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On 04/11/2023, Licensing Program Analyst (LPA) Candis Rodriguez conducted an unannounced Case Management inspection at facility to review sign in and out records and staff training records. LPA met with Site Supervisor Shoua Moua, explained purpose of inspection, toured the facility, and took a census.

Upon review of sign in and out sheets, LPA observed documentation to be complete with required daily signatures from authorized representatives.

Upon review of staff training records, LPA observed and obtained copies of training records indicating staff have been trained and have acknowledged policies around sign in and out procedures. LPA observed the facility training logs indicate procedures such as teaching staff standing next to sign in/out area and ensuring all required parent signatures are obtained. LPA observed facility documentation that parents were informed of the procedures.

Per Title 22, Division 12, Chapter 1 of the California Code of Regulations no deficiencies were observed today.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Site Supervisor Shoua Moua.

SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 341-4117
LICENSING EVALUATOR NAME: Candis RodriguezTELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2023
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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