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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 500305696
Report Date: 01/06/2020
Date Signed: 01/06/2020 03:22:56 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:GRACE LUTHERAN SCHOOLFACILITY NUMBER:
500305696
ADMINISTRATOR:GARCIA RACHELFACILITY TYPE:
850
ADDRESS:617 W.ORANGEBURG AVETELEPHONE:
(209) 522-6393
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY:90CENSUS: 22DATE:
01/06/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Rachel GarciaTIME COMPLETED:
03:45 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
LPA Claudia Henley conducted a case management visit today regarding an incident which occurred on 11/21/19. I was met by Director Rachel Garcia. There were 22 children present today.

LPA interviewed with the Director regarding Child #1. Director stated that Child #1 was terminated (per licensee/parent contract) from care on December 10, 2019 due to Child #1 to have continued behavioral issues towards staff. Director stated that staff had attempted a behavioral plan with the child and child's parents, but was not successful. LPA Henley received documents from the child's file showing the plan of action that was attempted with staff, child and parents.

BASED UPON INFORMATION THAT WAS OBTAINED FROM THE FACILITY STAFF, IT IS DETERMINED THAT THERE WERE NO VIOLATION OF CCL REGULATIONS. NO FURTHER ACTION IS REQUIRED AT THIS TIME.

Site Visit Notice posted on the parent board. Exit interview was conducted.

SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Claudia HenleyTELEPHONE: (559) 341-5776
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2020
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 1