240402889-8-12-2026-04-CC-SFVG-DWVUHC-20260812153544

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 240402889
Report Date: 08/12/2026
Date Signed: 08/12/2026 03:37:00 PM

Document Has Been Signed on 08/12/2026 03:37 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:	OUR LADY OF MIRACLES PRESCHOOL		FACILITY NUMBER:	240402889
ADMINISTRATOR/ DIRECTOR:	JOLEEN GOMES		FACILITY TYPE:	850
ADDRESS:	370 LINDEN AVENUE		TELEPHONE:	(209) 854-0017
CITY:	GUSTINE	STATE: CA	ZIP CODE:	95322
CAPACITY: 48	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	08/12/2026
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:20 PM
MET WITH:	Cindy Ribera		TIME VISIT/ INSPECTION COMPLETED:	03:45 PM

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On 08/12/2026, Licensing Program Analysts (LPAs), Sha Fee Vang and Miguel Herrera conducted an unannounced Annual Required Inspection for the preschool license. Licensee is Our Lady of Miracles Preschool. LPAs met with Officer Manager, Cindy Ribera and toured the facility indoors and outdoors. Monday through Friday 7:00 AM to 4:00 PM. The facility is closed for the summer and school will commence on 08/17/2026.

No poisons were observed during the inspection. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition allowed or stored on the premises.

LPA observed a storage area room that is accessible to children in care. Storage area contains various arts and crafts materials which includes cutting tools, paints, toys, and cleaning material that was made inaccessible during the inspection. LPA reviewed with staff that best practice would be to get a baby gate to make area inaccessible to children.

Although the facility had been closed for summer break, LPAs reminded Mrs. Ribera that the playground must be maintained. LPAs reminded Mrs. Ribera that prior to starting the school year staff need to ensure all play structures/toys are cleaned and swept for spider webs. LPAs reminded Mrs. Ribera to sweep the surface of the play yard as there was fecal matter mixed in the gravel. Mrs. Ribera stated that staff will deep clean the playground this weekend as school starts on Monday.

LPAs was informed that children do not drink water from fountains or fixtures in the facility. Drinking water is provided by personal water bottles and water dispenser located in both Classroom #7 and Classroom #8. This facility does not provide meals to children. Children bring their own food to the program and food is not prepared on site or off site. Facility has one or more functioning carbon monoxide detectors. Floors in the facility are clean and safe. To be continued on 809-C.

Joseph Pacheco
Sha Fee Vang
	DATE: 08/12/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: OUR LADY OF MIRACLES PRESCHOOL	FACILITY NUMBER: 240402889
	VISIT DATE: 08/12/2026

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Capacity and limitations as specified on the license are being maintained. At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at off-site activities. The name of the child care center director or fully-qualified teacher(s) designated to act in the director’s absence has been reported to the Department. LPAs did not review a sample of children’s files as the school year had not started. LPAs reviewed a sample of staff files and observed files were not complete with Mandated Reporter training's, health screening, immunization records for influenza, pertussis and measles for Staff #2, and Staff #3.

LPA discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to resources such as forms, regulations Provider Information Notices (PINs), and Quarterly Updates.

LPA discussed Reporting Requirements as outlined in the regulations (Section 101212).

Mrs. Ribera was reminded that all adults 18 and over, 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.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. 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). LPA verified that the lead testing was completed in accordance with the Written Directives outlined in PIN 21-21.1-CCP. LPA referred Mrs. Ribera to the Department website for lead: www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information. LPA was informed that the center does not use the facility’s water to drink or to prepare food.

(Continue on LIC809-C)

NAME OF LICENSING PROGRAM MANAGER: Joseph Pacheco
NAME OF LICENSING PROGRAM ANALYST: Sha Fee Vang
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/12/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2026

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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: OUR LADY OF MIRACLES PRESCHOOL	FACILITY NUMBER: 240402889
	VISIT DATE: 08/12/2026

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Director was informed of the MyChildCarePlan.org website; 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.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Exit interview conducted and report was reviewed with Office Manager, Cindy Ribera. Appeal rights were provided. Per Title 22, Division 12, of the California Code of Regulations, the following deficiency is being cited: (see next page). This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

NAME OF LICENSING PROGRAM MANAGER: Joseph Pacheco
NAME OF LICENSING PROGRAM ANALYST: Sha Fee Vang
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/12/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/12/2026 03:37 PM - It Cannot Be Edited

Created By: Sha Fee Vang On 08/12/2026 at 03:30 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: OUR LADY OF MIRACLES PRESCHOOL	FACILITY NUMBER: 240402889
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/12/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101217(d)

Personnel Records

(d) All personnel records shall be maintained at the child care center and shall be available to the licensing agency for review. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in that LPA observed that staff files for Staff#2, and Staff #3 were not complete with immunization, health records. and Manadated Reporter Trainings, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/26/2026
	Plan of Correction
1 2 3 4	Mrs. Ribera stated that she will ensure that staff #2 and staff #3 complete the AB1207 training and will provide a copy of the certificate via email/text by 08/26/2026.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Joseph Pacheco
NAME OF LICENSING PROGRAM MANAGER:

	Sha Fee Vang
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/12/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2026

LIC809 (FAS) - (06/04)

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