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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103810101
Report Date: 06/14/2021
Date Signed: 06/14/2021 01:42:50 PM

Document Has Been Signed on 06/14/2021 01:42 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:KINGDOM KIDS ACADEMY AT CLOVIS HILLSFACILITY NUMBER:
103810101
ADMINISTRATOR:COLLEEN DAVISFACILITY TYPE:
850
ADDRESS:10590 N. WILLOW AVETELEPHONE:
(559) 297-2600
CITY:CLOVISSTATE: CAZIP CODE:
93619
CAPACITY: 60TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/14/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Colleen DavisTIME COMPLETED:
02:00 PM
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On June 14, 2021, Licensing Program Analyst (LPA), Norma Lomeli conducted an announced Case Management- Licensee Initiated inspection to inspect an addressed shaded outdoor area. LPA met with Director, Colleen Davis who accompanied LPA during tour of the outside of the facility. LPA observed a large shade sail that connects high above and from the middle of the two classrooms which are located inside Modular Portable buildings. The shade sail is large enough to provide adequate shade for the day care children when they are playing outdoors. Director stated that the facility is scheduled to start operating on Monday, June 21, 2021.

Hours or operation are Monday through Friday from 9:00 AM to 12:00 PM.

Per California Code of Regulations, Title 22, Division 12, Chapter 1, no deficiency cited.



During exit interview, LPA observed Director, Colleen Davis post the Notice of Site Visit on parent’s board and understands it must remain posted for 30 days and retain evaluation report for 3 years.
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE: DATE: 06/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/14/2021
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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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: KINGDOM KIDS ACADEMY AT CLOVIS HILLS
FACILITY NUMBER: 103810101
VISIT DATE: 06/14/2021
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SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2021
LIC809 (FAS) - (06/04)
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