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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543808374
Report Date: 11/12/2019
Date Signed: 11/12/2019 10:25:10 AM

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:KRAYOLA KORNER SCHOOL READINESSFACILITY NUMBER:
543808374
ADMINISTRATOR:JOHNSON, SHARONFACILITY TYPE:
850
ADDRESS:420 N. E STREETTELEPHONE:
(559) 782-1234
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY:30CENSUS: 20DATE:
11/12/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Sharon Johnson, DirectorTIME COMPLETED:
10:30 AM
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LPA Pete Espinoza conducted Plan of Correction visit today regarding deficiencies cited on 11/04/2018. LPA met with Sharon Johnson, Director.

LPA reviewed children's files and observed copy of current medical assessment in each of child's files. LPA reviewed staff files and observed current Health Screening Report in each of the personnel files. LPA observed completed CPR certification for staff dated: 10/23/2019.

During visit LPA provided Letter of Deficiency Citations Cleared. Exit interview conducted with Sharon Johnson, Director.

Per California Code of Regulations Title 22, Division 12, no deficiency was cited during today's visit.

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
A Notice of Site Visit was posted on parent board.

To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Peter EspinozaTELEPHONE: 661-644-8231
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2019
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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