100405094-3-10-2020-04-CC-AMEA-BMKSGT-20200310135227

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 100405094
Report Date: 03/10/2020
Date Signed: 03/10/2020 01:52:40 PM

COMPREHENSIVE INSPECTION

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:	FIRST CHURCH OF GOD EARLY ENRICHMENT CENTER		FACILITY NUMBER:	100405094
ADMINISTRATOR:	ANTARAMIAN, LISA		FACILITY TYPE:	830
ADDRESS:	3920 N. FIRST STREET		TELEPHONE:	(559) 227-3222
CITY:	FRESNO	STATE: CA	ZIP CODE:	93726
CAPACITY:	20	CENSUS: 12	DATE:	03/10/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Director, Lisa Antaramian		TIME COMPLETED:	02:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 03/10/2020, an unannounced Annual inspection was conducted today by Licensing Program Analysts (LPAs) Angelica Mejia and Juvenal Moctezuma. LPAs met with Director Lisa Antaramian and toured the facility, both indoors and outdoors. Children are supervised at all times. The facility ensures that each infant is never left unattended and is under the direct visual supervision of a staff person at all times. The facility is in compliance with required staff-infant ratios. There are no bodies of water on site. Firearms/weapons are not allowed or stored on premises. Disinfectants, cleaning solutions and other dangerous items shall be inaccessible to children. Storage areas for poisons are locked. No poisons were observed during today’s visit. All materials and surfaces accessible to children are toxic free. All floors are clean and safe. There is sufficient infant napping equipment that is physically separated from the infant activity area. Infant indoor and outdoor activity space is separate from other components of the facility. Furniture and equipment are in good condition and free of sharp, loose, or pointed parts. Bottles, dishes, and containers of food brought by the infant's authorized representative are labeled with the infant's name and the current date. While in use, infant changing tables are placed within arm's reach of a sink. All kitchen, food prep, and storage areas are clean and free of litter, rubbish, and pests. All food is protected from contamination, and contaminated food is discarded immediately. All food and beverages capable of rapid spoiling are stored in covered containers at 45°(F) or less. Solid waste storage vessels, including moveable bins, have tight-fitting covers on and are in good repair. Uncontaminated drinking water is available both indoors and outdoors. Menus are posted at least one week in advance and are visible to authorized representatives. Playground equipment is in good condition and free of sharp, loose, or pointed parts. Outdoor activity space surface is maintained in a safe condition and is free of hazards. CCL shall notify a licensee to immediately terminate the employment of, or to remove/bar any person with specified convictions or for other reasons. The licensee shall comply with the notice. (Continued on LIC809-C)

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Angelica Mejia	TELEPHONE: (559) 341-6126
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: FIRST CHURCH OF GOD EARLY ENRICHMENT CENTER	FACILITY NUMBER: 100405094
	VISIT DATE: 03/10/2020

NARRATIVE

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Before working or volunteering in a licensed childcare facility, all individuals subject to a criminal record review have a clearance or exemption and have been associated to the facility. At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at off-site activities. A review of personnel and children’s records was conducted. Immunization records were missing for Staff #4 and all staff files did not contain documentation of annual Influenza immunization or declination. File for Staff #1, did not have proof of Mandated Reporter training AB 1207; all other staff completed required Mandated Reporter training. Children’s records include required consent for emergency medical treatment and an Infant Needs and Services Plan that includes an individual feeding plan. Child #1 and #3’s files did not have proof of Tuberculosis clearance. The person who signs the child in/out is responsible for the child, uses their full legal signature and records the time of day. Child's admission agreement is available for review. Required CCL forms are posted on parent's board. Days and hours of operation are Monday – Friday, 06:30 AM – 06:00 PM, and as arranged. This is a full day program which operates year-round.

This facility provides Incidental Medical Services (IMS). Licensee is aware that an IMS plan is required to be submitted to Community Care Licensing (CCL) within 30 days. LPAs reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Per Chapter 1, Division 12, Title 22 of the California Code of Regulations, the following deficiency was found: (see LIC809-D) Licensee was provided a copy of appeal rights. Site Visit Notice posted on the parent board. Exit interview was conducted with Director Lisa.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit form is required to be posted for 30 days.

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Angelica Mejia	TELEPHONE: (559) 341-6126
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: FIRST CHURCH OF GOD EARLY ENRICHMENT CENTER	FACILITY NUMBER: 100405094
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/10/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/10/2020 Section Cited	1 2 3 4 5 6 7	Employees...day care center; immunization requirements...(a)(1)Commencing September 1, 2016, a person shall not be employed...at a day care center if he or she has not been immunized...against measles. Each employee...shall receive an influenza vaccination between August 1 and December 1 of each year.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Based on record reviews and interview, Licensee did not maintain documentation of proof of measles immunization for Staff #4 and proof of influenza immunization for all staff. This poses a potential health, safety, or personal rights risk to the children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Angelica Mejia	TELEPHONE: (559) 341-6126
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020

LIC809 (FAS) - (06/04)

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