Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503808859
Report Date: 09/09/2015 12:00:00 AM
Date Signed 09/09/2015 04:30:47 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 E.SHAW AV,STE 300-MS 29-01
FRESNO, CA 93710
FACILITY NAME:BETHEL CHRISTIAN DAYCARE & PRESCHOOLFACILITY NUMBER:
503808859
ADMINISTRATOR:HAMMOND, KIMBERLYFACILITY TYPE:
830
ADDRESS:2361 SCENIC DRIVETELEPHONE:
(209) 521-5454
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:8CENSUS: 6DATE:
09/09/2015
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Director, Kim HammondTIME COMPLETED:
04:30 PM
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On this date LPA Kathie Campbell conducted an unannounced Case Management visit. Met with director, Kim Hammond and a tour of the facility was made. The licensee also operates a preschool at this site. Census was taken and sign in/out sheets were reviewed. Director asked LPA to look at a room that they may use to expand their infant program.

Per California Code of Regulations, Title 22, Division 12, Chapter 1 no deficiencies are cited during today's visit. An exit interview conducted with director, Kim Hammond.
A Notice of Site Visit Form to be posted to parent's board and must remain posted for 30 days.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)243-4588
LICENSING EVALUATOR NAME: Kathie CampbellTELEPHONE: (559) 341-4724
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2015
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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