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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503808081
Report Date: 03/13/2020
Date Signed: 03/13/2020 02:38:56 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 SCHOOL - EXTENDED SCHOOL CAREFACILITY NUMBER:
503808081
ADMINISTRATOR:VIGARS, JEFFFACILITY TYPE:
840
ADDRESS:617 W. ORANGEBURG AVENUETELEPHONE:
(209) 529-1800
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY:50CENSUS: 0DATE:
03/13/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Cindy StelleTIME COMPLETED:
03:15 PM
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LPA Claudia Henley conducted a case management today. The purpose of today's visit was to inspect the school age program due to a required one year visit that was due.

LPA was met by Cindy Stelle, Preschool Teacher/Assistant Director who stated that the school age program is only open in the summer time when elementary school is not in session. The school age program will not be in session this year until June 8, 2020 to July 31, 2020 starting 7:00 a.m. to 6:00 p.m. LPA advised Ms. Stelle that a note to this change will be made within the facility file for future for future reference by our department.

No deficiencies were cited.

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

DATE: 03/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2020
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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