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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203808111
Report Date: 04/01/2021
Date Signed: 04/01/2021 02:28:56 PM

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:ST. JOACHIM PRESCHOOLFACILITY NUMBER:
203808111
ADMINISTRATOR:SALAZAR, JENNYFACILITY TYPE:
850
ADDRESS:310 N I STTELEPHONE:
(559) 662-0372
CITY:MADERASTATE: CAZIP CODE:
93637
CAPACITY:48CENSUS: 4DATE:
04/01/2021
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Elizabeth MesaTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Brannon conducted a case management visit due to receiving an unusual incident report regarding child #1 receiving a positive COVID - 19 result.

During today's visit, LPA observed four preschool children with one preschool teacher. The children were wearing their face masks, LPA reviewed child #1 file and took a census. Classroom #2 is providing child care services. LPA conducted a telephone interview with principal, Ms. Heather Forcey.

Per California Code of Regulations Title 22, Division 12, no deficiency to be cited. Exit interview conducted with teacher, Elizabeth Mesa. A copy of this report need to be placed in facility file for public review. A Notice of Site Visit was posted on parent board.

A COPY OF THIS REPORT IS TO REMAIN IN THE FACILITY FOR PUBLIC REVIEW.
THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:

DATE: 04/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2021
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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