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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503808958
Report Date: 09/08/2023
Date Signed: 09/08/2023 12:27:34 PM

Document Has Been Signed on 09/08/2023 12:27 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:MODESTO CHRISTIAN PRESCHOOLFACILITY NUMBER:
503808958
ADMINISTRATOR:HALEY COSTAFACILITY TYPE:
850
ADDRESS:5755 SISK ROADTELEPHONE:
(209) 343-2321
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: DATE:
09/08/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Haley CostaTIME COMPLETED:
12:45 PM
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On 09/08/2023, Licensing Program Analysts (LPAs), Anita Tristan and Claribel Soto met with Director, Haley Costa for an unannounced Case Management- Inspection regarding an Unusual incident Report. LPAs toured the facility and a census was taken. An Unusual Incident Report was submitted to the Fresno Community Care Licensing Office (CCL) regarding an incident that occurred on 07/19/2023 were parent of child #1 was acting erratic.

During today's inspection LPA Tristan conducted interview with the Director Haley Costs to gather more information regarding the incident. There were no children present at the time of the incident. LPA observed that this was an isolated incident and was reported and handled in an appropriate manner.

Per Chapter 1, Division 12, Title 22 of California Code of Regulations no deficiencies are being cited today.

Exit interview conducted and report and appeal rights were reviewed and discussed with Director, Haley Costa

A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Anita Tristan
LICENSING EVALUATOR SIGNATURE: DATE: 09/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2023
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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