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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100406328
Report Date: 01/20/2023
Date Signed: 01/20/2023 02:59:50 PM


Document Has Been Signed on 01/20/2023 02:59 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-ADDAMSFACILITY NUMBER:
100406328
ADMINISTRATOR:MATHIES, DEANNAFACILITY TYPE:
850
ADDRESS:2117 W. MCKINLEYTELEPHONE:
(559) 457-3690
CITY:FRESNOSTATE: CAZIP CODE:
93728
CAPACITY:48CENSUS: 10DATE:
01/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Cherly Lopez and Sophia RailingTIME COMPLETED:
02:30 PM
NARRATIVE
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On 01/20/23 Licensing Program Analyst (LPA) Araceli Gibson, conducted an unannounced annual inspection. LPA met with Lead Teachers Sofia Railing and Cheryl Lopez. FUSD Addams preschool occupies classroom 37 and classroom 38 on a school campus. They operate for two sessions for preschool AM from 8:00 AM to 11:00 AM and PM session 11”30 AM to 2:30 PM Monday through Friday. Breakfast and lunches are provided and served in the Classroom. During today’s inspection between the two classrooms there was a census of 10 children total. LPA toured both classrooms inside and out for areas accessible to children in care.

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.

Playground, furniture and equipment are in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained safe and monitored for hazards. All toilets and handwashing facilities are in safe and sanitary. Floors in the facility are clean and safe. All food is protected against contamination and any contaminated food is discarded immediately. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors. Areas around high climbing equipment, swings and slides have cushioning material to absorb falls. The facility is free of flies, and rodents and are currently using a pest service for ants. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. As a condition of employment for is for all staff to have a fingerprint clearance through Fresno Unified School District 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. 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. continue 809C

SUPERVISOR'S NAME: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Araceli GibsonTELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:
DATE: 01/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/20/2023
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 5


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-ADDAMS
FACILITY NUMBER: 100406328
VISIT DATE: 01/20/2023
NARRATIVE
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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 designated to act in the director’s absence has been reported to the Department. This facility uses the Learning Genie to maintain signing children in/out of the facility by authorized representatives at the site. 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 when in person learning is conducted. 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 some were incomplete with health screening, immunization records for influenza, pertussis and measles (see 809D) and one staff missing current documentation of completed mandated reporter training (see 809D). Menus are posted at least one week in advance where an authorized representative can view them.

Incidental Medical Services (IMS) are currently being provided. 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.



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, no deficiencies are cited.

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 MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Araceli GibsonTELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 01/20/2023 02:59 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-ADDAMS
FACILITY NUMBER: 100406328

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/20/2023

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
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Based on record review, the licensee did not comply with the section cited above Staff unable to provide evidence of MMR, and TDAP and another staff missing verification of TB,.which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/20/2023
Plan of Correction
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Lead Teachers agree to obtain immunization record for staff 3 reflecting Tdap and MMR. Staff 1 to provide evidence of TB.
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
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Based on record review, the licensee did not comply with the section cited above in Staff 5 unable to provide evidence of current AB1207 Mandated Reporter training for child care providers, which poses potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/20/2023
Plan of Correction
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Lead teacher agrees to have Staff 5 provide evidence of current AB1207 Mandated Reporter training for child care providers.
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 MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Araceli GibsonTELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:
DATE: 01/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/20/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5