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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100403504
Report Date: 07/25/2023
Date Signed: 07/25/2023 04:11:35 PM

Document Has Been Signed on 07/25/2023 04:11 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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:FIRST CHURCH OF GOD EARLY ENRICHMENT CENTERFACILITY NUMBER:
100403504
ADMINISTRATOR:ANTARAMIAN LISAFACILITY TYPE:
850
ADDRESS:3920 NORTH FIRST STREETTELEPHONE:
(559) 227-3222
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY: 51TOTAL ENROLLED CHILDREN: 51CENSUS: 13DATE:
07/25/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Samantha EllsworthTIME COMPLETED:
04:30 PM
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On July 25, 2023, LPA A Mendoza and LPM C Brannon conducted a case management inspection. LPA A Mendoza and LPM C Brannon met with Assistant Director Samantha Ellsworth. During today’s inspection, LPA and LPM toured facility inside and outside areas. A census was taken during today's inspection. There were 13 children with two staff.

During today's inspection, LPA reviewed with Assistant Director, Samantha Ellsworth, requirements regarding bodies of water. Facility has three wading pools that are used for water play. LPA observed that water in the three wading pools. The children were napping and there were no children without adult supervision.

No deficiencies cited during today's inspection.

Exit interview conducted and report was reviewed with the assistant director. This report shall be made available to the public upon request. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Aurelio Mendoza
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2023
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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