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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100406318
Report Date: 06/29/2022
Date Signed: 06/29/2022 11:20:31 AM

Document Has Been Signed on 06/29/2022 11:20 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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:FUSD-LINCOLNFACILITY NUMBER:
100406318
ADMINISTRATOR:MATHIES, DEANNAFACILITY TYPE:
850
ADDRESS:651 B STREETTELEPHONE:
(559) 457-3690
CITY:FRESNOSTATE: CAZIP CODE:
93706
CAPACITY: 22TOTAL ENROLLED CHILDREN: 22CENSUS: 7DATE:
06/29/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Charoltte MirandaTIME COMPLETED:
11:45 AM
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On 6/29/22 Licensing Program Analyst (LPA) Caroline Harris conducted a Plan of Correction inspection. LPA met with Teacher, Karen Jones. A census was taken and there were 7 children present.

The purpose of the inspection is to review staff and children's files per deficiencies and technical violations cited on 6/21/22. LPA reviewed children's files and observed copies of Personal Rights and medical provider information in each of the children's files. In staff files, LPA observed signed Criminal Record Statements, completed Mandated Reporter training, and a staff file for the substitute. Proof of immunizations (MMR, T-Dap) were available for the substitute but not for the teacher. The substitute is also missing her health screening and both the substitute and teacher are needing proof of TB test.

During today’s inspection, LPA provided a Letter of Deficiency Citations Cleared. An exit interview was conducted with Charoltte Miranda. Per Chapter 1, Division 12, Title 22 of the California Code of Regulations, no deficiency was cited during today’s inspection.

A copy of this report and LIC 9213 Notice of Site Inspection were provided to Charoltte Miranda. This report shall be made available to the public upon request. LIC 9213 Notice of Site Inspection is required to be posted for 30 days.

To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Caroline Harris
LICENSING EVALUATOR SIGNATURE: DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2022
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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