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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543808548
Report Date: 05/21/2019
Date Signed: 05/21/2019 02:49:22 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:PORT NAZ CHRISTIAN ACADEMYFACILITY NUMBER:
543808548
ADMINISTRATOR:PITCHER, KARENFACILITY TYPE:
850
ADDRESS:2005 W. OLIVE AVENUETELEPHONE:
(559) 784-5437
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY:96CENSUS: 62DATE:
05/21/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Karen Pitcher, DirectorTIME COMPLETED:
03:00 PM
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A case management inspection was conducted today by Licensing Program Analyst, Pete Espinoza. LPA met with, Karen Pitcher, Director, to discuss incident which occurred on 05/06/2019. A complete file review was conducted prior to visit. LPA toured facility inside and outside. Census was taken. LPA interviewed staff and observed area in which incident occurred.

Director stated a Parent reported to her that she observed Teacher place Child in chair in a manner she felt was excessive. Director stated she observed the video indicating Child was misbehaving in classroom and Teacher attempted to place child in chair for time-out. Director stated there was no injury to child and staff followed personnel policies regarding discipline. Director stated she observed the video with Teacher and Church administrative staff. Director stated Teacher was placed on Administrative leave effective 05/10/2019.

Per California Code of Regulations Title 22, Division 12, no deficiency cited during today's visit. Exit interview conducted with the Karen Pitcher, Director.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.

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: 05/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019
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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