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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503810176
Report Date: 03/28/2022
Date Signed: 04/06/2022 04:15:22 PM


Document Has Been Signed on 04/06/2022 04:15 PM - It Cannot Be Edited

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:DAVIS PARK CHRISTIAN ACADEMY INCFACILITY NUMBER:
503810176
ADMINISTRATOR:GRAY, BUDDYFACILITY TYPE:
850
ADDRESS:901 W RUMBLE RDTELEPHONE:
(209) 642-0597
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY:60CENSUS: 0DATE:
03/28/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Michelle EllisTIME COMPLETED:
12:30 PM
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On 03/28/2022, Licensing Program Analyst (LPA) Juvenal Moctezuma conducted an unannounced Prelicensing inspection and met with President - Michelle Ellis, Site Supervisor Angela Madrid, & Teacher Brittany Ellis. The purpose of todays inspection was to make sure that all the corrections that were requested during the prelicensing inspection conducted on 2/15/22 were fixed and taken care of. LPA explained the reason of the inspection and a tour of the center was conducted both inside and outside. LPA did a walk though of the center and observed that Michelle has corrected some of the items that were requested. The only items pending are the fencing out in the play area. Michelle stated that she will get additional chain links and make sure the fence is secure all around. Michelle understands that she will shave the thread bolts to a recommended size 3/4. There is a broken basketball hoop structure that needs to be removed. Michelle will send over the specifications for the shade structure to make sure it will provide enough shade for children year round. Michelle will also make sure the doors leading into the Sanctuary are secure so the public doesn't have access into the preschool area. Michelle also understands that children will not have contact with anyone that's not fingerprint cleared and/or associated to the facility.

Exit interview conducted and report was reviewed with the Michelle Ellis.

No deficiencies cited during today's visit.


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: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:
DATE: 03/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/28/2022
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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