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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543801168
Report Date: 11/07/2019
Date Signed: 11/12/2019 12:03:22 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:CCGI LEARNING CENTER AND CHILD CARE PROGRAMFACILITY NUMBER:
543801168
ADMINISTRATOR:JOHNSON, AMIFACILITY TYPE:
840
ADDRESS:9514 W. PERSHING AVENUETELEPHONE:
(559) 651-2244
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY:14CENSUS: 0DATE:
11/07/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Ami Johnson - DirectorTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Jessika Thompson conducted an unannounced annual/random inspection. LPA met with Director Ami Johnson. A tour of the facility, inside and outside, as shown on the facility sketch was performed. This program operates year around, Monday through Friday. There are no bodies of water. Firearms and ammunition are not on the premises. Furniture, equipment and materials are sufficient, age appropriate, in good repair and toxic free. Rooms and floors are safe and clean. Breakfast snack and afternoon snack is provided, lunch is provided by parents and/or authorized representatives of children in care. The licensee is taking measures to keep the facility free of insects, rodents, etc. No excluded adults are present at the facility. Conditions, limitations and capacity specified on license are in compliance. Staff subject to a criminal record clearance or exemption is associated to the facility. First Aid/CPR reviewed and in compliance. Facility has at least one functioning carbon monoxide detector that is in place. Teacher/child ratios are maintained, and adequate supervision is provided during visit. Menus are posted. A sample of children's and staff’s records reviewed. Children’s records include required information including; Name, address and telephone number of child’s authorized representative and relatives and/or others who can assume responsibility in the event authorized representative cannot be reached. Staff records contain required documentation of the educational background, training, proof of immunization, and Child Abuse Mandated Reporter certification. Lead safety was discussed, and LPA provided Director Johnson with a brochure. Director Johnson understands that lead safety information must also be provided to parents and/or authorized representatives of children in care. Provider Information Notices were discussed, and Director Johnson is aware that forms and updated information may be obtained on the Community Care Licensing Division’s website: (www.ccld.ca.gov). Earthquake safety was discussed and form LIC-9148, Earthquake Preparedness Checklist, is posted on parent’s board. Incidental Medical Services (IMS) are not currently being provided. Director Johnson was advised that if/when any IMS is provided, a Plan for Providing IMS must be submitted to the Department.

(Continued on LIC809-C)
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika ThompsonTELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019
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: CCGI LEARNING CENTER AND CHILD CARE PROGRAM
FACILITY NUMBER: 543801168
VISIT DATE: 11/07/2019
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Per California Code of Regulations, Title 22, Division 12, no deficiencies were observed today.

An exit interview was conducted with Director Johnson.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika ThompsonTELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2