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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543801186
Report Date: 08/15/2024
Date Signed: 08/15/2024 02:51:46 PM

Document Has Been Signed on 08/15/2024 02:51 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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:GOSHEN ELEMENTARY SCHOOL PRESCHOOLFACILITY NUMBER:
543801186
ADMINISTRATOR/
DIRECTOR:		HENDRICK, JOSETTEFACILITY TYPE:
850
ADDRESS:6505 AVENUE 308TELEPHONE:
(559) 730-7847
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: DATE:
08/15/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Margaret McLainTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 08/15/24, Licensing Program Analyst (LPA) Christopher Burnias and Licensing Program Manager (LPM) Kari McWilliams went to the facility for the purpose of a case management inspection of newly added playground equipment installed at the facility. LPA met with ECE Lead Margaret McLain and toured the facility. During the summer, ECE Lead informed LPM McWilliams that playground equipment was being replaced and requested an inspection by the Department to approve use of playground equipment.

Upon inspection of the playground, LPA observed various age appropriate playground equipment including a play structure with slides and climbing areas which shows a sticker showing age use of 2 years old to 5 years old .

The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. Areas around the playground equipment have new sponge turf installed to provide cushion to absorb falls.

LPA approved the playground equipment, and may now be used by the facility.

Exit interview conducted and report was reviewed with ECE Lead Margaret McLain. Appeal rights were provided.

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

SUPERVISORS NAME: Luisa Gavoutian
LICENSING EVALUATOR NAME: Christopher Burnias
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2024
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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