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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 240402889
Report Date: 12/05/2024
Date Signed: 12/05/2024 04:34:08 PM

Document Has Been Signed on 12/05/2024 04:34 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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:OUR LADY OF MIRACLES PRESCHOOLFACILITY NUMBER:
240402889
ADMINISTRATOR/
DIRECTOR:		JOLEEN GOMESFACILITY TYPE:
850
ADDRESS:370 LINDEN AVENUETELEPHONE:
(209) 854-0017
CITY:GUSTINESTATE: CAZIP CODE:
95322
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 17DATE:
12/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Elizabeth RodriguezTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
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On 12/05/2024 Licensing Program Analyst (LPA), Stephanie Vega-Gonzalez, conducted an unannounced Case Management Inspection. LPA was informed that the Director was not present, yet LPA could discuss inspection with Teacher Assistant, Elizabeth Rodriguez. LPA toured the facility indoors and outdoors and a census was taken. LPA explained the purpose of the unannounced inspection.

The purpose of the inspection was due to an incident that had occurred on November 8, 2024, regarding Child #1. Based on the information obtained, this appears to be an isolated incident and staff took the appropriate measures to address the incident.

Nonetheless, the Department was not notified of the incident until November 15, 2024. LPA was informed by Teacher Assistant that the Director had been out and was not able to report until November 15, 2024. LPA reviewed Title 22 CCR 101212 Reporting Requirements with Teacher Assistant. LPA reviewed LIC 308 Designation of Facility Responsibility with Teacher Assistant. Teacher Assistant, Elizabeth Rodriguez stated they understood.

Exit interview conducted and report was reviewed with Teacher Assistant, Elizabeth Rodriguez

Appeal rights were provided.

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

This report shall be made available to the public upon request.

LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Stephanie Vega-Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2024
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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