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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100407038
Report Date: 10/04/2019
Date Signed: 10/04/2019 08:37:19 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:FIREBAUGH-LAS DELTAS UNIFIED SCHOOL DISTRICTFACILITY NUMBER:
100407038
ADMINISTRATOR:SANCHEZ, DELIA M.FACILITY TYPE:
850
ADDRESS:1691 "Q" STREETTELEPHONE:
(559) 659-3117
CITY:FIREBAUGHSTATE: CAZIP CODE:
93622
CAPACITY:144CENSUS: 89DATE:
10/04/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Debbie WoodTIME COMPLETED:
09:00 AM
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 LPA Brannon met with Director of Educational Services, Debie Wood. During today's visit, LPA inspected the two remodeled children's bathroom. The two children's bathrooms have a total of 3 toilets, 1 urinal and 2 sinks. The bathrooms can be used by the children. Licensee is aware that the doors, in the bathroom, leading to storage areas are to be kept locked.
During today's visit, LPA reviewed with Debbie Woods that the name on their site banners do not correspond with the name listed on the application. The banners state Bailey's Preschool. The application lists the facility name as Firebaugh-Las Deltas Unified School District. The name of the facility needs to be addressed and changed if needed. LPA provided a listing of documents that is required to make a facility name change.
Per California Code of Regulations Title 22, Division 12, no deficiency cited during today's visit. Exit interview conducted with Director of Educational Services, Debie Wood. A copy of this report need to be placed in facility file for public review. A Notice of Site Visit was posted on parent board.

The following documents should be posted at the facility:
Ø PUB 269 – child passenger restraint systems poster
Ø PUB 393 – Notification of Parents Rights
Ø License
Ø Menus
Ø LIC 613A – Personal Rights form
Ø LIC 610 – Disaster Plan
Ø LIC 9148 – Earthquake Preparedness Checklist

A COPY OF THIS REPORT IS TO REMAIN IN THE FACILITY FOR PUBLIC REVIEW.
THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2019
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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