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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543810129
Report Date: 05/18/2021
Date Signed: 05/18/2021 03:07:33 PM

Document Has Been Signed on 05/18/2021 03:07 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:BOINGOS ACADEMY PHIT CLUBFACILITY NUMBER:
543810129
ADMINISTRATOR:CEBALLOS, ALYSSAFACILITY TYPE:
840
ADDRESS:7131 W PERSHING CTTELEPHONE:
(559) 623-9206
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 45TOTAL ENROLLED CHILDREN: 0CENSUS: 39DATE:
05/18/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Alyssa CeballosTIME COMPLETED:
10:30 AM
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On 05/18/2021, Licensing Program Analyst (LPA) Juvenal Moctezuma conducted an unannounced case management inspection and met with Owner, Alyssa Ceballos. LPA explained the reason of the inspection and a tour of the center was conducted both inside and outside. LPA provided Alyssa with the Prelicensing Reports and obtained signatures from the inspection that was conducted on 05/13/2021. LPAs computer went into consistency Check during the inspection and was not able to finish the report.

During todays inspection, LPA observed that the excess cabinetry has been removed from all classrooms. Alyssa stated that she is almost done with all the corrections. LPA notified Alyssa to notify CCL once she has completed them since another inspection will be required before she can get licensed.

No deficiencies cited during today's visit.


A COPY OF THIS REPORT IS TO REMAIN IN THE FACILITY FOR PUBLIC REVIEW.
THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Juvenal Moctezuma
LICENSING EVALUATOR SIGNATURE: DATE: 05/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/18/2021
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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