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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100405479
Report Date: 10/24/2019
Date Signed: 10/24/2019 12:35:06 PM

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:BIG CREEK ELEMENTARY SCHOOLFACILITY NUMBER:
100405479
ADMINISTRATOR:WAIT, TOBYFACILITY TYPE:
850
ADDRESS:55190 POINT ROADTELEPHONE:
(559) 893-3314
CITY:BIG CREEKSTATE: CAZIP CODE:
93605
CAPACITY:15CENSUS: 0DATE:
10/24/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:TIME COMPLETED:
01:00 PM
NARRATIVE
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An unannounced annual inspection was conducted today by Licensing Program Analysts (LPAs) Candis Rodriguez and Caroline Harris. LPAs met with Teacher Romelyn Kennedy and toured the facility, both indoors and outdoors. During today’s inspection, there were no children in attendance at the preschool.
There are no bodies of water on site. Firearms/weapons are not allowed or stored on premises. Teacher states all children are under visual supervision at all times. Disinfectants, cleaning solutions and other dangerous items are inaccessible to children. No poisons were observed during today’s visit. All materials and surfaces accessible to children are toxic free. All toilets, hand washing, and bathing facilities are in safe and sanitary operating conditions. All floors are clean and safe. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. Uncontaminated drinking water is available both indoors and outdoors. Menus are posted at least one week in advance, where an authorized representative can view them. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. The preschool utilizes the swings, sandbox and fenced field area for outdoor play. Areas around swings have cushioning material to absorb falls.
Upon review of personnel files, LPAs observed multiple missing required licensing forms from Teacher’s file. After reviewing children’s files, LPAs observed Child #1’s file missing all required licensing forms, and Child #2 missing two required licensing forms.

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. Before working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have a clearance or exemption and have been associated to the facility. Staff records contain appropriate, documentation of education credits. At least one person trained in CPR and Pediatric first-aid is present when children are at the facility or at off-site activities. 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. (Continued on LIC 809C)
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis RodriguezTELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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: BIG CREEK ELEMENTARY SCHOOL
FACILITY NUMBER: 100405479
VISIT DATE: 10/24/2019
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This is a half day program which operates on a traditional school year schedule. Hours of operation are Tuesday through Thursday, 8:30am to 11:30am.

Required CCL forms are posted on parent's board.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if she provides these services. The following information regarding Americans with Disability Act (ADA) was provided: US Department of Justice toll free ADA Information line at (800) 514-0301(voice) and (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm for Commonly Asked Questions about Child Care Centers and the ADA.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINS), Quarterly Updates, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Chapter 1, Division 12, Title 22 of the California Code of Regulations, the following deficiencies are found: (see LIC809-D). Site Visit Notice posted on the parent board. Exit interview was conducted with Romelyn Kennedy.

Licensee was provided a copy of appeal rights.

SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis RodriguezTELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: BIG CREEK ELEMENTARY SCHOOL
FACILITY NUMBER: 100405479
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/12/2019
Section Cited

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Personnel Records. Personnel records shall be maintained on the licensee, administrator, and each employee, and shall contain specified information. This requirement was not met as evidenced by LPAs observation of multiple required licensing forms missing from staff file. This poses a potential risk to the health, safety,
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and personal rights of children in care.
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Type B
11/12/2019
Section Cited

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Child's Records. A separate, complete and current record for each child shall be maintained in the child care center. This requirement was not met as evidenced by LPAs observation of two children's files missing required licensing forms. This poses a potential risk to the health, safety, and personal rights
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of children in care.
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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: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis RodriguezTELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2019
LIC809 (FAS) - (06/04)
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