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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 163808460
Report Date: 11/14/2019
Date Signed: 11/14/2019 11:28:15 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:KINGS CHRISTIAN SCHOOL, INC.FACILITY NUMBER:
163808460
ADMINISTRATOR:HARTIG, REBECCAFACILITY TYPE:
850
ADDRESS:900 EAST D STREETTELEPHONE:
(559) 924-8301
CITY:LEMOORESTATE: CAZIP CODE:
93245
CAPACITY:30CENSUS: 23DATE:
11/14/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Rebecca HucknallTIME COMPLETED:
11:45 AM
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On this date, Licensing Program Analysts (LPAs) Ruby Ocegueda and Kathy Pacheco conducted an unannounced case management - incident inspection. LPAs met with Rebecca Hucknall, toured the facility, and took a census. The purpose of today's inspection was to follow-up on an unusual incident that was reported to Community Care Licensing (CCL) on 11/6/19. The incident reported was regarding a child falling during music time.

During today's inspection, LPAs interviewed staff regarding the unusual incident and confirmed the information reported on 11/6/19. LPA's also reviewed the child's file, and inspected the area where the child fell. It was observed that there were no tripping hazards in the carpet area where the child fell. Per Director Hucknall, parent did not obtain any documentation from the doctor visit to provide to the facility. Child was able to return the same day as the incident.

After reviewing the incident with Director Hucknall, it was determined that the facility followed regulations and followed all appropriate reporting procedures. The incident is an isolated incident and not a result of lack of care and supervision.

No deficiencies cited in the areas observed today.

This report is to be made available to the public upon request.
LIC 9213 Notice of Site Visit to be posted for 30 days.
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ruby OceguedaTELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2019
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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