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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103810257
Report Date: 11/06/2024
Date Signed: 11/06/2024 03:29:04 PM

Document Has Been Signed on 11/06/2024 03:29 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:INCLUSION LEARNING CENTER-CLOVIS HILLS CHURCHFACILITY NUMBER:
103810257
ADMINISTRATOR/
DIRECTOR:
MONICA PETERSONFACILITY TYPE:
860
ADDRESS:10590 N WILLOW AVETELEPHONE:
(209) 329-6792
CITY:CLOVISSTATE: CAZIP CODE:
93619
CAPACITY: 15TOTAL ENROLLED CHILDREN: 10CENSUS: 4DATE:
11/06/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Elizabeth GonzalezTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On 11/6/2024, Licensing Program Analyst (LPA), Yesenia Fierro conducted an unannounced Case Management Inspection-Licensee Initiated. The purpose of the inspection was to review staff, volunteer, and children files. LPA met with Director, Elizabeth Gonzalez and explained the reason for the inspection. A census was taken, and LPA conducted a tour of facility inside and outside.

On today's date LPA reviewed staff, volunteer, and children files. LPA observed staff and children files were complete. LPA observed volunteer files were missing documentation. LPA advised Director Elizabeth Gonzalez that missing documentation needs to be collected before volunteers return to the facility.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, no deficiency is being cited. Notice of Site Inspection to be posted for 30 days. Appeal Rights were provided.

SUPERVISORS NAME: Kari McWilliams
LICENSING EVALUATOR NAME: Yesenia Fierro
LICENSING EVALUATOR SIGNATURE: DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2024
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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