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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103810257
Report Date: 01/30/2024
Date Signed: 01/30/2024 11:45:53 AM

Document Has Been Signed on 01/30/2024 11:45 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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:INCLUSION LEARNING CENTER-CLOVIS HILLS CHURCHFACILITY NUMBER:
103810257
ADMINISTRATOR:MONICA PETERSONFACILITY TYPE:
850
ADDRESS:10590 N WILLOW AVETELEPHONE:
(559) 360-5090
CITY:CLOVISSTATE: CAZIP CODE:
93619
CAPACITY: 15TOTAL ENROLLED CHILDREN: 15CENSUS: 0DATE:
01/30/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Monica Peterson - DirectorTIME COMPLETED:
12:00 PM
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On 1/30/24, Licensing Program Analysts (LPAs) Joseph Pacheco and Yesenia Fierro conducted an announced pre-licensing inspection and met with Facility Representative, Gaukue Xiong. LPAs reviewed the reason of the inspection, and a tour of the center was conducted both inside and outside. The center is located at the address 10590 N. Willow Ave. Clovis, CA 93619. Licensee is Inclusion Learning Center. Facility is located on the premises of Clovis Hills Church on the southern part of the campus. This is a new facility, and the applicant is requesting a license for 15 preschool children ages 2-6. This facility does not provide a Toddler option program. This program will operate year round Monday through Friday with full day and half day options. Full day is from 7:00 am – 3:30 pm. The AM session is from 7:00 am – 11:30 am. The PM session is from 11:30 am – 3:30 pm. This program will operate in Classroom 212. Classroom 213 is where the staff bathroom is located and where sick children will isolate. Ill children will use the staff bathroom. Classroom 213 will also be utilized to provide supplemental services to children after operating hours. Parents will be with their children when these supplemental services are provided. Applicant is aware to contact the Fresno Community Care Licensing office for a change in classrooms and/or change in capacity. Parents will escort the children to the classroom and staff will conduct the daily health check.
Representative stated that the center will provide breakfast, lunch, AM and PM snacks. Food will be prepared at a kitchen located on the premises on the other side of the outdoor activity area.
The classroom was observed to be clean and free of toxins. LPA observed that the furniture and equipment appeared to be safe and in good condition. The cubbies are anchored to prevent tipping onto children in care. Tall play furniture which can easily be tipped over will need to be anchored.
There are enough tables, cubbies, chairs and plenty of toys for children to play with. LPA also reminded Coordinator to not store anything on top of high shelves that could potentially fall on children. Facility will need to obtain a working Carbon Monoxide detector.
LPAs reviewed with Representative, that any future changes to the classrooms are required to ensure that furniture does not tip over on to children, the furniture are to be anchored or situated that tipping does not occur.
CONTINUED ON LIC809-C
SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Joseph Pacheco
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: INCLUSION LEARNING CENTER-CLOVIS HILLS CHURCH
FACILITY NUMBER: 103810257
VISIT DATE: 01/30/2024
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Classroom changes of furniture shall be situated that 100% visual supervision is always provided to children in care.
Room measurements were taken and reviewed with Representative. The total inside preschool area measured to an approximate 726 square feet which will accommodate the requested capacity of 15 preschool children. Representative understands that children's equipment needs to match the capacity Inclusion Learning Center is licensed for. Toys and equipment appear to be age appropriate. There is a total of 1 toilet and 1 sink/hand washing fixtures which will accommodate the requested capacity of 15 preschool children. Applicant will be providing toilet training. Facility will be providing drinking water during indoor activities from water bottles purchased at the store. LPAs observed a water fountain outside which will provide drinking water during outdoor activities. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).
The outside square footage is approximately 6,088 square feet which will accommodate requested capacity of 15 preschool children. LPAs observed age appropriate toys and play equipment. LPAs observed a high climbing play structure with wood chips for cushioning. A shade tarp between Classrooms 212 and 213 provide a shaded rest area. LPAs observed a pop up tent providing additional shade. LPAs reminded Representative that visual supervision is to be provided to children in care at all times.
Facility Representative was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.
A fire clearance for a capacity of 15 preschool children ages 2-6 was approved and granted by the Fresno County Fire Department on 10/4/23.

The following items must be completed prior to issuing a license:

Inside Daycare:
1) Anchor play equipment in the corner to prevent from tipping over.
2) Obtain and install a working carbon monoxide detector.
SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Joseph Pacheco
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: INCLUSION LEARNING CENTER-CLOVIS HILLS CHURCH
FACILITY NUMBER: 103810257
VISIT DATE: 01/30/2024
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A return inspection will be needed to verify the above items have been corrected.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. Applicant has provided an IMS plan to the Fresno Regional Office. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Pending a final file review and completion of the above items, a recommendation will be made to license the above facility for the requested capacity of 15 preschool children.

The following documents should be posted at the facility:
* PUB 269- Child passenger restraint systems poster 101225(f) Transportation
* Pub 393- Notification of Parents Rights 101218.1(c) Admission Procedures
* License 101160(a) License
* Menus 101227(a)(6) Food Services
* LIC 613A- Personal Rights form 101223(b)(2) Personal Rights
* LIC 610- Disaster Plan 101174(a)
* LIC 9148- Earthquake Preparedness Checklist 101174(b)
* Activity Schedule
* Lead Poisoning brochure

Representative was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.
CONTINUED ON LIC809-C
SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Joseph Pacheco
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: INCLUSION LEARNING CENTER-CLOVIS HILLS CHURCH
FACILITY NUMBER: 103810257
VISIT DATE: 01/30/2024
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Exit interview conducted and report was reviewed with Facility Representative, Gaukue Xiong.

A COPY OF THIS REPORT IS TO REMAIN IN THE FACILITY FOR PUBLIC REVIEW.
THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.

To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Joseph Pacheco
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4