100406318-6-21-2022-04-CC-CHAS-CFLSCM-20220621134546

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 100406318
Report Date: 06/21/2022
Date Signed: 06/21/2022 01:46:00 PM

Document Has Been Signed on 06/21/2022 01:46 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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	FUSD-LINCOLN		FACILITY NUMBER:	100406318
ADMINISTRATOR:	MATHIES, DEANNA		FACILITY TYPE:	850
ADDRESS:	651 B STREET		TELEPHONE:	(559) 457-3690
CITY:	FRESNO	STATE: CA	ZIP CODE:	93706
CAPACITY:	22	CENSUS: 5	DATE:	06/21/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Charoltte Miranda		TIME COMPLETED:	02:30 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 6/21/22 an unannounced Annual inspection was conducted today by Licensing Program Analyst, (LPA) Caroline Harris. LPA met with Heath and Safety Supervisor, Charlotte Miranda and toured the facility, both indoors and outdoors. The LPA observed all required licensing forms to be posted in a visible location for authorized representatives to view them. A census was taken and there were five day care children present. This facility runs from 8:00-11:00 am Monday threw Friday. Afternoon snack is provided. Menus are posted at least one week in advance, where an authorized representative can view them. Firearms/weapons or ammunition are not allowed or stored on the premises. All children are under supervision, including visual supervision, of a teacher at all times. There is a ratio of one teacher supervising no more than 12 children in attendance. The LPA did not observe disinfectants, cleaning solutions and other dangerous items to be accessible to children. There were no poisons observed on the premises accessible to children. Licensee is aware that poisons are required to be locked and inaccessible to children. 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. There is a working fire extinguisher, smoke detector, carbon monoxide indicator, and adequate heating and ventilation for safety and comfort. The licensee has a complete first aid kit, including bandages, scissor, thermometer, gloves and a first aid manual. Uncontaminated drinking water is available both indoors and outdoors. Playground equipment is in good condition, free of sharp, loose, or pointed parts. Outdoor activity space surface is maintained in a safe condition and is free of hazards. Areas around high climbing equipment, swings, and slides have cushioning material to absorb falls. There were no bodies of water on site.

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Caroline Harris	TELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2022

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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Document Has Been Signed on 06/21/2022 01:46 PM - 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-LINCOLN	FACILITY NUMBER: 100406318
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on file review, staff files did not show proof of T-Dap, MMR or influenza. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/28/2022
	Plan of Correction
1 2 3 4	The facility representative agrees to have all staff immunizations available for review by the due date of 6/28/22. A return visit will take place to clear this deficiency.

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on file review, the teachers Mandated Reporter training expired on 1/14/22 and the sub did not have proof of completing. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/28/2022
	Plan of Correction
1 2 3 4	The facility representative agrees to have all staff complete the Mandated Reporter training by the due date of 6/28/22. A return visit will take place to clear this deficiency.

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: Caroline Harris	TELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/21/2022 01:46 PM - 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-LINCOLN	FACILITY NUMBER: 100406318
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101170(d)

Criminal Record Clearance

(d) All individuals subject to criminal record review shall, be fingerprinted and sign a Criminal Record Statement (LIC 508 [Rev. 1/03]) under penalty of perjury. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on file review, staff files did not show proof of signing the LIC 508. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/28/2022
	Plan of Correction
1 2 3 4	The facility representative agrees to have all staff complete the LIC 508 and have it available for review by the due date of 6/28/22. A return visit will take place to clear this deficiency.

Type B

Section Cited

CCR

101217(a)

Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on file review, the teachers file was not complete and the sub did not have a file available. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/28/2022
	Plan of Correction
1 2 3 4	The facility representative agrees to have complete staff files available for review by the due date of 6/28/22. A return visit will take place to clear this deficiency.

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: Caroline Harris	TELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2022

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-LINCOLN	FACILITY NUMBER: 100406318
	VISIT DATE: 06/21/2022

NARRATIVE

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The facility representative was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated. There are no excluded individuals present at this facility. Licensee is aware that upon notice from the Department, any excluded individual must be immediately removed from the facility and prevented from returning to the center or having contact with children in care. The licensee shall comply with the notice. The teachers file contain appropriate, documentation of education credits. At least one person is to be trained in CPR and Pediatric first-aid and shall be present when children are at the facility or at off-site activities. This facility does have one person trained in CPR and first aid. Upon file review, the teachers file was not complete and the substitute did not have a file. Staff records did not contain documentation of immunizations against pertussis, measles or influenza for staff. LPA reviewed with the teacher, Karen Jones the Mandated Child Abuse Reporter Training (AB 1207), which she completed on 1/14/20. The Mandated Reporter Training is required to be updated every two years. The LPA and licensee discussed the Community Care Licensing website: www.ccld.ca.gov. which provides access to Provider Information Notifications (PINS), Quarterly Updates that inform licensees of new legislation and regulations, training's, and Licensing forms and updated information. The licensee was also advised that it is her responsibility to stay current with regulations. Fire drills are conducted and documented with the date, time and how many children present, every six months. The person, who signs the child in/out, is responsible for the child, uses their full legal signature and records the time of day. The LPA reviewed five children’s files. Children's files did not have all required licensing documents available for review. Licensee did maintain documentation of immunizations for the children. Incidental Medical Services (IMS) policy was discussed. This facility does not have any children taking medications at this time. The licensee is aware that an IMS plan is required to be submitted to the licensing office if they choose to provide any of these services.

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Caroline Harris	TELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2022

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-LINCOLN	FACILITY NUMBER: 100406318
	VISIT DATE: 06/21/2022

NARRATIVE

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Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiencies are found: (see LIC809-D)

An exit interview was conducted and a copy of this report, along with appeal rights was provided and reviewed with Charlotte Miranda. This report shall be made available to the public upon request. The LIC 9213 Notice Of Site Visit form was given to Ms. Miranda and must remain posted for 30 days.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Caroline Harris	TELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2022

LIC809 (FAS) - (06/04)

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