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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 540403661
Report Date: 04/20/2023
Date Signed: 04/20/2023 12:16:06 PM

Document Has Been Signed on 04/20/2023 12:16 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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:FIRST BAPTIST PRESCHOOLFACILITY NUMBER:
540403661
ADMINISTRATOR:STOCKTON, ELISAFACILITY TYPE:
850
ADDRESS:81 N G STTELEPHONE:
(559) 784-6688
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 44TOTAL ENROLLED CHILDREN: 44CENSUS: 27DATE:
04/20/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Virginia TuckerTIME COMPLETED:
12:45 PM
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On April 20, 2023 Licensing Program Analyst (LPA) Nancy Her conducted an unannounced case management inspection to amend report, LIC 9099 dated 03/30/2023.

LPA met with Director Virginia Tucker and toured the facility and a census was taken.

LPA and Director discussed amended report; report was changed from Confidential to Public. LPA and Director signed the amended report.

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

Exit interview conducted and report was reviewed with Facility Representative Virginia Tucker.
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Nancy Her
LICENSING EVALUATOR SIGNATURE: DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/20/2023
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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