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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503810176
Report Date: 05/13/2022
Date Signed: 05/13/2022 11:38:50 AM


Document Has Been Signed on 05/13/2022 11:38 AM - 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:
05/13/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Michelle EllisTIME COMPLETED:
11:45 AM
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On May 13, 2022, Licensing Program Analysts (LPAs) C Brannon and J Pacheco conducted an announced Prelicensing inspection. LPAs met with President - Michelle Ellis, Site Supervisor Angela Madrid and Teacher Brittany Ellis. The purpose of today's inspection was to make sure that the following corrections were made that were listed on the 3/29/22 inspection:

1) Fencing is now secure.

2) Thread bolts on the fencing was shaved down to required length.

3) The broken portable basketball hoop has been removed. There is one portable basketball hoop in the cemented outside play yard.

4) A shade structure has been installed. Michelle Ellis stated a gazebo has been purchased for the outside play yard. LPA informed Michelle Ellis, that the gazebo will need to be inspected by Licensing before children are allowed to use the shade structure.

Michelle Ellis will ensure that the doors leading into the Sanctuary are secure so the public doesn't have access into the preschool area. Michelle Ellis also understands that children will not have contact with anyone that's not fingerprint cleared and/or associated to the facility.

Classrooms #2, #3, #7, #8 #9, #10 and #11 are for preschool children. This facility is located at the Davis Park Church of Christ. Parents will enter in the door located on Napier Dr. There are two adjacent outside play yards: one is cement and the other contains the shade structure and climbing structure.

During today's inspection, LPAs observed a 'designated smoking area' designated from the church, who is renting to licensee. During today's inspection, LPA reviewed Title 22, section 101231: Smoking Prohibition - Smoking is prohibited on the premises of a child care center as specified in Health and Safety Code Section 1596.795(b). CONTINUED ON FOLLOWING PAGE

SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 388-3635
LICENSING EVALUATOR SIGNATURE:
DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/13/2022
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 2


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: DAVIS PARK CHRISTIAN ACADEMY INC
FACILITY NUMBER: 503810176
VISIT DATE: 05/13/2022
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Per Michelle Ellis, she will speak to Pastor William "Buddy" Gray, to ensure that the the Smoking Designation sign is removed and smoking area is removed to ensure children are not exposed to second or third hand smoke.

A fire clearance for 60 preschool children was received and granted by the Modesto Fire Department on 01/27/2022.

Pending a final file review, a recommendation will be made to license the above facility for the requested capacity of 60 preschool children.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with President - Michelle Ellis.

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) 388-3635
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2022
LIC809 (FAS) - (06/04)
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