100406316-11-8-2023-04-CC-SVGZ-CXDMBD-20231108082742

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 100406316
Report Date: 11/06/2023
Date Signed: 11/08/2023 08:28:43 AM

Document Has Been Signed on 11/08/2023 08:28 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	FUSD-HOLLAND		FACILITY NUMBER:	100406316
ADMINISTRATOR:	MADDEN, KATHERINE		FACILITY TYPE:	850
ADDRESS:	4676 N. FRESNO		TELEPHONE:	(559) 457-3690
CITY:	FRESNO	STATE: CA	ZIP CODE:	93726
CAPACITY:	22	CENSUS: 6	DATE:	11/06/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Alejandra Arenas		TIME COMPLETED:	03:30 PM

NARRATIVE

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On 11/6/2023 Licensing Program Analyst (LPA) Stephanie Vega-Gonzalez, conducted an unannounced Annual Required Inspection for the Preschool age license. LPA met with preschool teacher, Alejandra Arenas (Staff 1) also present was Health and Safety Supervisor, Charlotte Miranda and Staff 2, Staff 3, and Staff 4, and Staff 5. LPA toured the facility indoors and outdoors and a census was taken. The days and hours of operations are composed of two preschool sessions. First preschool session is from 8:00am to 11:00am Monday through Friday. The second preschool session is from 11:30pm to 2:30pm Monday through Friday.

LPA observed a RAID ant Killer poison in an unlatched cabinet. Poison was on the top shelf located in the back of shelf, and was inaccessible to children in care. LPA observed as a staff took poison and tossed it out in the school’s trash bins, located outside of facility. LPA reviewed with staff regulations on keeping all poisons under lock and key. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible on the top shelf of an unlatched cabinet. LPA discussed with Staff 1 that best practice would be to have a latch on cabinet.

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.

Furniture and equipment are in good condition, free of sharp, loose or pointed parts. LPA observed that playground equipment does have wear and tear. LPA observed various cracks on playground structure’s rubber and steps. LPA was informed that a work order had been placed and that a new playground structure will be installed in Summer of 2024. LPA reviewed with staff to communicate with licensing before and after installations. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. Areas around high climbing equipment and slides have cushioning material to absorb falls. All toilets and hand washing facilities are in safe and sanitary operating condition. Facility has one or more functioning carbon monoxide detectors. Floors in the facility are clean and safe.

(Continue on LIC809-C)

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Stephanie Vega-Gonzalez	TELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2023

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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Document Has Been Signed on 11/08/2023 08:28 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: FUSD-HOLLAND	FACILITY NUMBER: 100406316
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101217(d)

Personnel Records

(d) All personnel records shall be maintained at the child care center and shall be available to the licensing agency for review. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in that LPA observed that Staff 2, Staff 4, and Staff 5 did not have a personnel file on site. LPA observed that Staff 2 had taken the incorrect Mandated Reporter, and that Staff 4 and Staff 5 did not have a Mandated Reporter on file. LPA was informed that Staff do have a file, yet are located off site, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/20/2023
	Plan of Correction
1 2 3 4	Licensee stated that they will submit a file for Staff 2, Staff 4, and Staff 5 including a copy of the Mandated Reporter certificate.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Stephanie Vega-Gonzalez	TELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2023

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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: FUSD-HOLLAND	FACILITY NUMBER: 100406316
	VISIT DATE: 11/06/2023

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Drinking water is available both indoors and outdoors. Drinking water is provided by drinking fountains. This facility does provide meals to children, snacks are provided. Food is prepared on site. Menus are posted at least one week in advance where an authorized representative can view them.

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 off site 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. All children are under supervision, including visual supervision, of a teacher at all times. Facility meets teacher child ratios. 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 and medical assessment. LPA reviewed a sample of staff files and observed files were complete for Staff 1 and Staff 3 with health screening, immunization records for influenza, pertussis and measles and current documentation of completed mandated reporter training. LPA observed that Staff 1 had an updated Pediatric CPR and FA certificate that expires on 8/25/2025. LPA observed that Staff 2, Staff 4, and Staff 5 did not have a complete file or mandated reporter certificate on site. Staff are fingerprint cleared as a condition of employment through Fresno Unified School District.

LPA discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to resources such as forms, regulations Provider Information Notices (PINs), and Quarterly Updates.

LPA discussed Reporting Requirements as outlined in the regulations (Section 101212).

Alejandra Arenas was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of

(Continue on LIC809-C)

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Stephanie Vega-Gonzalez	TELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2023

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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: FUSD-HOLLAND	FACILITY NUMBER: 100406316
	VISIT DATE: 11/06/2023

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licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). LPA verified that the lead testing was completed in accordance with the Written Directives outlined in PIN 21-21.1-CCP. LPA referred Alejandra Arenas to the Department website for lead: www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information.

Facility does not care for infants.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

Alejandra Arenas was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Exit interview conducted and report was reviewed with Alejandra Arenas. Appeal rights were provided.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiency is being cited: (see next page).

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.

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Stephanie Vega-Gonzalez	TELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2023

LIC809 (FAS) - (06/04)

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