100407037-9-20-2019-04-CC-GBAA-BG7NWX-20190920105017

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 100407037
Report Date: 09/20/2019
Date Signed: 09/20/2019 10:50:23 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:	PACIFIC UNION ELEMENTARY SCHOOL		FACILITY NUMBER:	100407037
ADMINISTRATOR:	JENNINGS, WARREN		FACILITY TYPE:	850
ADDRESS:	2065 E. BOWLES AVE.		TELEPHONE:	(559) 834-2533
CITY:	FRESNO	STATE: CA	ZIP CODE:	93725
CAPACITY:	24	CENSUS: 15	DATE:	09/20/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Donna Flores		TIME COMPLETED:	11:00 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	An annual random inspection was conducted on this date by Licensing Program Analysts (LPAs) Ginny Badhesha and Kathy Pacheco. LPAs met with Site Supervisor/Teacher Donna Flores and toured the facility. There was one assistant, Camello Gallardo, and 15 day care children present during today’s inspection. Preschool classroom (Room #1) is used for child care and is located on the Pacific Union Elementary School grounds. Days and hours are Monday through Friday from 8:15 AM to 2:15 PM. This facility operates a morning (8:15am to 11:15am) and afternoon (11:15am to 2:15pm) class during the traditional school year. No bodies of water present. Firearms/weapons are not allowed or stored on premises. All children present receive direct visual supervision at all times. There is a ratio of one teacher and one assistant supervising no more than 18 children in attendance. Facility is operating within the approved licensed capacity at this inspection. All disinfectants, cleaning solutions, toxic, poisonous items, and medications are inaccessible to children. All toilets, hand washing, and bathing facilities are in safe and sanitary condition. All floors are clean and safe. Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Breakfast and lunch is prepped and served in the school cafeteria and children are escorted by staff to the cafeteria. Solid waste storage vessels, including moveable bins, have tight fitting covers on, and are in good repair. Uncontaminated drinking water is available both indoors and out. Menus are posted at least one week in advance where an authorized representative can view them. Facility has at least one functioning carbon monoxide detector that meets statutory requirements. Playground equipment is in good condition, free of sharp, loose, or pointed parts. Outdoor activity space surface is maintained in safe condition and free of hazards. Areas under/around high climbing equipment, swings, and slides have sufficient bark cushioning material to absorb falls. Licensee does not exceed the conditions, limitations, and capacity specified on the license. Staff records contain appropriate documentation of education credits. At least one person (Donna Flores) trained in Pediatric CPR/First Aid with the expiration date of 8/18/2021, is present when children are at the facility or at off site activities. (Continued on 809-C)

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Gagandip Badhesha	TELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2019

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: PACIFIC UNION ELEMENTARY SCHOOL	FACILITY NUMBER: 100407037
	VISIT DATE: 09/20/2019

NARRATIVE

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The responsible person who signs the child in/out uses their full legal signature and records the time of day. Child's admission agreement is available for review. Site Supervisor Donna Flores will provided update copies of LIC 500 (Personnel Report), LIC 610 (Emergency Disaster Plan) and LIC 308 (Designation of Facility Responsibility).

Incidental Medical Services (IMS) are not 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.

Licensee was provided with Lead Poisoning Facts brochure.

Per California Code of Regulations, Title 22, Division 12, Chapter 1, in the areas evaluated no deficiency was cited during today's visit.

Exit interview conducted with Site Supervisor Donna Flores and a copy of this report was provided and discussed.

A Notice of Site Visit Form (LIC 9213) was posted on parent's board and must remain posted for 30 days.

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Gagandip Badhesha	TELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2019

LIC809 (FAS) - (06/04)

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