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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203810070
Report Date: 08/06/2019
Date Signed: 08/06/2019 02:34:00 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:YOSEMITE LAKES COMMUNITY CHURCH KIDS IN CHRISTFACILITY NUMBER:
203810070
ADMINISTRATOR:HECKMAN, BRENDAFACILITY TYPE:
840
ADDRESS:43840 PATRICK AVETELEPHONE:
(559) 440-6777
CITY:COARSEGOLDSTATE: CAZIP CODE:
93614
CAPACITY:45CENSUS: 15DATE:
08/06/2019
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Brenda HeckmanTIME COMPLETED:
03:00 PM
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Licensing Program Analyst Brannon met with Children's Pastor, Brenda Heckman. LPA verified the following was corrected.

1. A waiver for sharing the outside play yard with the preschool, and a copy of the outside play yard schedule showing when the preschool and school age children are utilizing the play yard. Waiver and schedule has been sent in.
2. The bathrooms in portable 1 and in portable 2 have tall cabinets with items stored on top. These items are to be removed. The items were removed.
3. Portable 2 bathroom has rust on the wall under the sink. This area shall be repaired. Area repaired.
4. In the walk way that the children use to go to the outside play area has wooden boards that need to be removed. The boards have been removed.
5. Licensee is required to have a drinking water source for the children in each portable classroom. Licensee cannot use the bathroom sink as drinking water. Drinking water is provided by water dispenser with disposable cups and dispenser.
6. Director and staff shall have their fingerprint clearance added to the school age license. Fingerprint paperwork was sent in.
CONTINUED ON FOLLOWING PAGE
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2019
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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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: YOSEMITE LAKES COMMUNITY CHURCH KIDS IN CHRIST
FACILITY NUMBER: 203810070
VISIT DATE: 08/06/2019
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Pending a final file review and completion of above items, a recommendation will be made to license the above facility for a capacity of 42 school age children. Licensee shall
Please update LIC 500, LIC 610, LIC 308, Facility Sketch upon licensure.

The following documents should be posted at the facility:
* PUB 269- Child passenger restraint systems poster 101225(f) Transportation
* Pub 393- Notification of Parents Rights 101218.1(c) Admission Procedures
* License 101160(a) License
* Menus 101227(a)(6) Food Services
* LIC 613A- Personal Rights form 101223(b)(2) Personal Rights
* LIC 610- Disaster Plan 101174(a)
* LIC 9148- Earthquake Preparedness Checklist 101174(b)

Exit interview conducted with Children's Pastor, Brenda Heckman.
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2019
LIC809 (FAS) - (06/04)
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