240402889-9-8-2025-04-CC-AMEA-DLBU2S-20250908151226

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 240402889
Report Date: 09/08/2025
Date Signed: 09/08/2025 03:12:33 PM

Document Has Been Signed on 09/08/2025 03:12 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 PRESCHOOL		FACILITY NUMBER:	240402889
ADMINISTRATOR/ DIRECTOR:	JOLEEN GOMES		FACILITY TYPE:	850
ADDRESS:	370 LINDEN AVENUE		TELEPHONE:	(209) 854-0017
CITY:	GUSTINE	STATE: CA	ZIP CODE:	95322
CAPACITY: 48	TOTAL ENROLLED CHILDREN: 48	CENSUS: 11	DATE:	09/08/2025
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:30 AM
MET WITH:	Staff #1		TIME VISIT/ INSPECTION COMPLETED:	03:30 PM

NARRATIVE

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On 09/08/2025, Licensing Program Analyst (LPA) Aurelio Mendoza conducted an unannounced Case Management – Other inspection to review reporting requirements related to a change in director. During the inspection, LPA conducted a tour of the facility inside and outside, took a census of children in care, and interviewed Staff #1.

Staff #1 reported that a change in director occurred in July 2025. During today’s visit, Staff #1 provided documentation related to the Change of Director; however, upon review, LPA determined that the packet was incomplete and additional information is required in order for Child Care Licensing to key in the new director as the official point of contact for the facility. LPA directed Staff #1 to submit a complete Change of Director packet as soon as possible to ensure compliance and to establish a current director of record.

A Technical Advisory is being provided under California Code of Regulations, Title 22, Division 12, Chapter 1, Section 101212(b) – Reporting Requirements, which states:

“The name of the child care center director, and any fully qualified teacher(s) designated to act in the child care center director's absence, shall be reported to the Department within 10 days of a change of child care center director or designee(s).”

This section was reviewed in detail with Staff #1, and a checklist of required documents was emailed to assist in completing the Change of Director process.

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

An exit interview was conducted with Staff #1. A copy of this report was provided and reviewed. This report shall be made available to the public upon request. The LIC 9213 Notice of Site Visit form was issued and is required to be posted for 30 days.

NAME OF LICENSING PROGRAM MANAGER: Joseph Pacheco
NAME OF LICENSING PROGRAM ANALYST: Aurelio Mendoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/08/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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