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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100406315
Report Date: 01/14/2022
Date Signed: 01/14/2022 12:31:52 PM

Document Has Been Signed on 01/14/2022 12:31 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:FUSD-DEL MARFACILITY NUMBER:
100406315
ADMINISTRATOR:MATHIES, DEANNAFACILITY TYPE:
850
ADDRESS:4122 N. DEL MARTELEPHONE:
(559) 457-3685
CITY:FRESNOSTATE: CAZIP CODE:
93704
CAPACITY: 21TOTAL ENROLLED CHILDREN: 21CENSUS: 11DATE:
01/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Ka Lee-HerTIME COMPLETED:
01:00 PM
NARRATIVE
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On 1/14/2022, Licensing Program Analyst (LPA) Ruby Ocegueda, conducted an unannounced Annual Required Inspection for the preschool license. LPA met with Site Supervisor Ka Lee-Her, and toured the facility indoors and outdoors. Days and hours of operation are Monday-Friday 8:00 AM -11:00 AM and 11:30 AM -2:30 PM. This facility is located inside Del Mar Elementary and operates on a traditional school year schedule.

There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. No poisons were observed during the inspection.

Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Playground equipment is in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space was inspected, and it was observed that there was a crack in the cement walk way that was lifted and also breakage on the cement that caused a hole. This was reviewed with Site Supervisor Ka Lee-Her who confirmed the observation and she agreed that this was a tripping hazard. All toilets and hand washing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe. This facility provides an individual pre-sealed snack for both the AM and PM class. The snack is provided by the school district nutrition center. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors. Each child is given their own bottled water that is labeled with their name. The bottled waters are accessible to children. Areas around high climbing equipment, swings and slides have cushioning material to absorb falls. The facility is free of flies, insects and rodents.

Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have received a criminal record clearance or exemption. Report continued on 809-C

SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2022
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: FUSD-DEL MAR
FACILITY NUMBER: 100406315
VISIT DATE: 01/14/2022
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Upon notification from the Department, the licensee will comply and act immediately to terminate the employment of, remove from the facility or bar from entering the facility for any person it is deemed necessary while the Department considers granting or denying an exemption.

Capacity and limitations as specified on the license are being maintained. At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at offsite activities. The name of the child care center director or fully-qualified teacher(s) designated to act in the director’s absence has been reported to the Department. The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. All children are under supervision, including visual supervision, of a teacher at all times. Facility maintains a ratio of one teacher supervising no more than 12 children in care. LPA reviewed a sample of children’s files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child. Three out of ten files reviewed had missing Physicians Report and 10 out of 10 files had missing LIC 613A Personal Rights form. Site Supervisor Ka Lee-Her confirmed the record review observation. LPA reviewed a sample of staff files and observed files were complete with health screening, immunization records for influenza, pertussis and measles and current documentation of completed mandated reporter training. Menus are posted at least one week in advance where an authorized representative can view them.

Incidental Medical Services (IMS) are currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.



LPA and Site Supervisor discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiencies are being cited: (see next page, 809 D) Licensee was provided a copy of their appeal rights.

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

SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/14/2022 12:31 PM - It Cannot Be Edited


Created By: Ruby Ocegueda On 01/14/2022 at 11:59 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: FUSD-DEL MAR
FACILITY NUMBER: 100406315

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238.2(d)
Outdoor Activity Space
(d) The surface of the outdoor activity space shall be maintained:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. It was observed by LPA Ocegueda and Site Supervisor that there was a crack that caused lifting on the cement and breakage in a different area of the cement that made a hole. This could cause tripping of children in care. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/11/2022
Plan of Correction
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Site Supervisor will communicate the observation with her office manager who will complete a work order so that the cement could be repaired and show proof of work order and repair by POC date 2/11/2022.
Type B
Section Cited
CCR
101220(a)
Child's Medical Assessments
(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited. Three out of ten records reviewed showed that medical assessments were missing for children #1, #2, #3. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/11/2022
Plan of Correction
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Licensee will submit proof of medical assessment or physicians report for children #1, #2, #3 to the Department by POC date 2/11/2022.
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:Michael Duarte
LICENSING EVALUATOR NAME:Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE:
DATE: 01/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/14/2022


LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 01/14/2022 12:31 PM - It Cannot Be Edited


Created By: Ruby Ocegueda On 01/14/2022 at 11:59 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: FUSD-DEL MAR
FACILITY NUMBER: 100406315

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101223(b)(1)
Personal Rights
(1) The center shall give each authorized representative a copy of the Personal Rights form (LIC 613A [9/96]).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview, the licensee did not comply with the section cited above. LPA observed that in 10 out of 10 files reviewed, the LIC 613A was missing. Site Supervisor confirmed the observation. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/11/2022
Plan of Correction
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Site Supervisor printed a copy of LIC 613A today and will be providing copy to each parent to review and sign. Proof will be submitted to the Department by POC date 2/11/2022.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Michael Duarte
LICENSING EVALUATOR NAME:Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE:
DATE: 01/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/14/2022


LIC809 (FAS) - (06/04)
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