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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100407037
Report Date: 01/10/2022
Date Signed: 01/10/2022 02:04:44 PM

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 SCHOOLFACILITY NUMBER:
100407037
ADMINISTRATOR:JENNINGS, WARRENFACILITY TYPE:
850
ADDRESS:2065 E. BOWLES AVE.TELEPHONE:
(559) 834-2533
CITY:FRESNOSTATE: CAZIP CODE:
93725
CAPACITY:24CENSUS: 7DATE:
01/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Jasmine Kang / Eva VillegasTIME COMPLETED:
02:30 PM
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On 01/10/22, Licensing Program Analyst (LPA) Angelica Slaughter conducted an unannounced annual inspection at the facility. LPA met with Substitute Teacher, Ms. Jasmine Kang and Assistant Ms. Eva Villegas and toured the facility indoors and outdoors. Preschool classroom (Room #1) is used for child care and is located on the Pacific Union Elementary School grounds. Days and hours of operation 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. Currently, there is only a morning class, as there are not enough children enrolled to operate an afternoon class. There were no bodies of water, firearms and/or ammunition on the premises. No poisons were observed during the inspection. Furniture and equipment were in good condition, free of sharp, loose or pointed parts. Playground equipment was in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space was maintained in a safe condition and was free of hazards. Areas around high climbing equipment and slides have wood chip cushioning material to absorb falls. Children's toilets and hand washing facilities were sanitary and in good operating condition. Floors in the facility were clean and safe. Solid waste storage containers had tight-fitting covers and were in good repair. Menus are posted at least one week in advance where an authorized representative can view them. All meals are prepped in the school cafeteria. Breakfast and lunch are served in the cafeteria. Drinking water was available both indoors and outdoors. The facility had one or more functioning carbon monoxide detectors that meet statutory requirements.

Capacity and limitations as specified on the license are being maintained. 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. The facility maintains a ratio of one teacher supervising no more than 12 children in care. All children are under supervision, including visual supervision, of a teacher at all times. The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. A sample of children's files were reviewed and contained contact information for authorized representative and/or relatives or others who can assume responsibility for the child and medical assessment.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Angelica SlaughterTELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2022
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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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: 01/10/2022
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LPA was unable to review staff files, as files are maintained off site, at a different location. 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 facility operates under West Park Preschool Consortium and staff have a fingerprint clearance as a condition of employment through the corresponding school district.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation interpretations and Procedures for Child Care Centers Section 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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

LPA and Substitute Teacher Jasmine Kang discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 1 of the California Code of Regulations, the following deficiencies were found (see next page, 809 D):

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Substitute Teacher Jasmine Kang.

SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Angelica SlaughterTELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/10/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101174(d)(2)
Disaster and Mass Casualty Plan
(d) Disaster drills shall be conducted at least every six months. (2) The drills shall be documented. This documentation shall be kept in the child care center for at least one 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 in that there is no written record of fire drills being maintained in the classroom, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/07/2022
Plan of Correction
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Facility will submit proof of documentation of fire drills to CCLD by the POC due date of 02/07/22.
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
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Based on record review, the licensee did not comply with the section cited above in that staff files are not kept or maintained on site as required by the regulations, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/07/2022
Plan of Correction
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Facility will maintain a copy of staff files on site. Facility to submit proof to CCLD by the POC due date of 02/07/22.
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: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Angelica SlaughterTELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:
DATE: 01/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/10/2022
LIC809 (FAS) - (06/04)
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