100406335-8-5-2019-04-CC-CBRN-BERNCW-20190805102124

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 100406335
Report Date: 08/05/2019
Date Signed: 08/05/2019 10:21:34 AM

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-JEFFERSON		FACILITY NUMBER:	100406335
ADMINISTRATOR:	MADDEN, KATHERINE (KAY)		FACILITY TYPE:	850
ADDRESS:	202 N. MARIPOSA		TELEPHONE:	(559) 457-3000
CITY:	FRESNO	STATE: CA	ZIP CODE:	93701
CAPACITY:	21	CENSUS: 0	DATE:	08/05/2019
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Mary Anne Moreno		TIME COMPLETED:	10:30 AM

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	A prelicensing inspection visit was conducted on this date by Licensing Program Analyst (LPA) Brannon, who met with Special Teacher Assignment, Mary Anne Moreno. The center is located at Jefferson Elementary. The licensee is requesting the following capacity of 21 preschool children. This program will operate traditional school year, Monday thru Friday from 8:00 AM to 4:00 PM. Breakfast and lunch are optional and provided in the school cafeteria; morning and afternoon snacks will be provided. There is not a sink with hot water inside classroom to use for food preparation. Ill children and staff will utilize the bathroom located in the school nurse's office. Ill children will be isolated in the nurse's office. During today's inspection, measurements taken and reviewed with Mary Anne Moreno. There is one classroom, 27, that will be used by preschool children. The total preschool square footage is 871 which will accommodate 21 preschool children. There are 3 toilets, 1 urinal and 4 sinks/hand washing fixtures in the children's bathrooms which will accommodate the requested capacity of 21 preschool children. There is a drinking water fountain in the classroom, which will be utilized for indoor drinking water. There are waivers for the shared bathroom and play yard. CONTINUED ON FOLLOWING PAGE

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia Brannon	TELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2019

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-JEFFERSON	FACILITY NUMBER: 100406335
	VISIT DATE: 08/05/2019

NARRATIVE

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Per Mary Anne Moreno, outdoor storage is available for toys and equipment. Toys and equipment are age appropriate. Outdoor measurements taken on this date total 10058 square feet which will accommodate the requested capacity. Adequate shade is available in the outdoor activity area. Licensee is utilizing mature trees as shade. The applicant is using wood chip for cushioning under the outdoor climbing structure. There is a drinking water fountain to be utilized for outdoor drinking water.

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 Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

CONTINUED ON FOLLOWING PAGE

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia Brannon	TELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2019

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-JEFFERSON	FACILITY NUMBER: 100406335
	VISIT DATE: 08/05/2019

NARRATIVE

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The following items must be completed prior to issuing a license by August 9, 2019:
1. The inside lighting is missing a row of lights.
2. There are roaches in the children's bathrooms. Pest control is needed to spray the inside of the bathrooms to ensure bathrooms are insect free. Roaches have been known to cause asthma and other health related issues.
3. Cubbies are on order and have not been delivered.
4. Waiting for fire clearance for 21 preschool children.

Pending a final file review and completion of above items, a recommendation will be made to license the above facility for a capacity of 21 preschool children.

The following documents should be posted at the facility:
* PUB 269- Child passenger restraint systems poster 101225(f) Transportation
* Pub 393- Notification of Parents Rights 101218.1(c) Admission Procedures
* License 101160(a) License
* Menus 101227(a)(6) Food Services
* LIC 613A- Personal Rights form 101223(b)(2) Personal Rights
* LIC 610- Disaster Plan 101174(a)
* LIC 9148- Earthquake Preparedness Checklist 101174(b)

To order forms, etc. visit our website at www.ccld.ca.gov.

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia Brannon	TELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2019

LIC809 (FAS) - (06/04)

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