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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103808837
Report Date: 08/07/2023
Date Signed: 08/07/2023 12:01:05 PM

Document Has Been Signed on 08/07/2023 12:01 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:JEFFERSON STATE PRESCHOOLFACILITY NUMBER:
103808837
ADMINISTRATOR:TUPPER, MEGANFACILITY TYPE:
850
ADDRESS:1296 E. WASHINGTONTELEPHONE:
(559) 305-7237
CITY:REEDLEYSTATE: CAZIP CODE:
93654
CAPACITY: 36TOTAL ENROLLED CHILDREN: 36CENSUS: 11DATE:
08/07/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Lead Teacher, Carla DouhanTIME COMPLETED:
12:00 PM
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On 08/07/2023 Licensing Program Analyst (LPA) Jose Penate and Licensing Program Manager (LPM) Duane Matsubara, conducted an unannounced Case Management Inspection and was met by Lead Teacher, Carla Douhan and a census was taken. The purpose of today’s inspection was to clear POC and to review the plan that was created to ensure supervision while children are at outdoor play.

During today’s inspection, LPA and LPM reviewed new directives given to staff and inspected outdoor zoning areas of the playground, where staff will have visual supervision at all times.

Facility will stay in compliance with California Code of Regulations Title 22 Division 12 Chapter 1 regulations, as well as California Health & Safety Code laws related to childcare centers, at all times. Lead Teacher was informed of childcare training videos available on the Community Care Licensing website at www.ccld.ca.gov.

Community Care Licensing will increase frequency of site inspection visits to the facility.

It was discussed that continued violation of California Code of Regulations and Health & Safety Code laws related to childcare centers may result in a Non-Compliance meeting and/or will be referred to the Legal Division for possible Administrative Action.



This report was read aloud to Lead Teacher on today’s date.

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 the Lead Teacher, Carla Douhan.

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

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Jose Penate
LICENSING EVALUATOR SIGNATURE: DATE: 08/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2023
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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