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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153810036
Report Date: 02/03/2022
Date Signed: 02/03/2022 12:34:00 PM

Document Has Been Signed on 02/03/2022 12:34 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:WONDERFUL PRESCHOOL: LOST HILLSFACILITY NUMBER:
153810036
ADMINISTRATOR:HIXON, ALESHAFACILITY TYPE:
850
ADDRESS:14848 LAMBERSON AVETELEPHONE:
(661) 706-7689
CITY:LOST HILLSSTATE: CAZIP CODE:
93249
CAPACITY: 264TOTAL ENROLLED CHILDREN: 264CENSUS: 32DATE:
02/03/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Donna Ward TIME COMPLETED:
12:45 PM
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On 02/03/21 Licensing Program Analyst (LPAs) Araceli Gibson and Juvenal Moctezuma conducted an unannounced case management inspection to address an incomplete director packet submission to CCL and outstanding annual fees owed. LPA's met with Site Supervisor, Donna Ward. LPAs discussed with Site supervisor the importance of keeping current on annual fees, and reporting responsibilities regarding to changes to director. California Code of Regulations Title 22, 101187 (a)(e) and 101212 (1).

LPA Gibson assisted Site Supervisor with the payment process online. LPAs provided Site Supervisor technical assistance with items still needed to process and finalize the director change.

Per California Code of Regulations Title 22, Division 12, Chapter 1 no deficiency cited during today's visit. Exit interview conducted with the Site Supervisor.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Araceli Gibson
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2022
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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