100407038-9-6-2023-04-CC-JPAO-CVEMZZ-20230906100359

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 100407038
Report Date: 09/06/2023
Date Signed: 09/06/2023 10:04:03 AM

Document Has Been Signed on 09/06/2023 10:04 AM - 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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	FIREBAUGH-LAS DELTAS UNIFIED SCHOOL DISTRICT		FACILITY NUMBER:	100407038
ADMINISTRATOR:	SERNA, PAMELA		FACILITY TYPE:	850
ADDRESS:	1691 Q ST		TELEPHONE:	(559) 659-3117
CITY:	FIREBAUGH	STATE: CA	ZIP CODE:	93622
CAPACITY:	144	CENSUS: 58	DATE:	09/06/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Pamela Serna - Director		TIME COMPLETED:	10:15 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	On 9/6/23, Licensing Program Analyst (LPA) Joseph Pacheco conducted an unannounced Case Management inspection and met with Director, Pamela Serna and toured the facility both inside and outside. Licensee is requesting to decrease their preschool capacity from 144 to 120 preschool children. The facility plans to utilize Classrooms 26 through 30. This program operates on a traditional school year schedule with full day and part day options. Full day is Monday – Friday, 6:45am – 5:30pm. Part day is Monday – Friday, 8:00am – 11:30am. LPA explained to Director the reason for today's inspection which was to follow up on a previous Case Management inspection that took place on 4/24/23. The total inside preschool area of the classroom measured to an approximate 4,268 square feet which will accommodate the requested capacity of 120 preschool children. There are a total of 10 toilets and 15 sinks/hand washing fixtures which will accommodate 120 preschool children. Outdoor measurements were not taken during today's inspection as Licensee is decreasing capacity. A fire clearance for 120 preschool children ages 2-6 was given by the Firebaugh Fire Department on 8/6/23. Today LPA verified the following items have been completed: Inside Activity Area · Cubbies in all classrooms have been anchored to prevent tipping. · Classroom 30 has been cleaned and arranged in a way so that it’s ready to provide care and supervision. Outdoor Activity Area · Facility is utilizing water pitchers and sippy cups during outdoor activities for Classrooms 26 & 27 to make water readily available. CONTINUED ON LIC809-C

SUPERVISOR'S NAME: Deborah Lowe	TELEPHONE: (916) 661-7243
LICENSING EVALUATOR NAME: Joseph Pacheco	TELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: FIREBAUGH-LAS DELTAS UNIFIED SCHOOL DISTRICT	FACILITY NUMBER: 100407038
	VISIT DATE: 09/06/2023

NARRATIVE

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Pending a final file review , the new license will reflect the decrease of the preschool capacity from 144 to 120 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)
* Activity Schedule
* Lead Poisoning brochure

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, no deficiencies are cited.

Exit interview conducted and report was reviewed with Director, Pamela Serna.

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

SUPERVISOR'S NAME: Deborah Lowe	TELEPHONE: (916) 661-7243
LICENSING EVALUATOR NAME: Joseph Pacheco	TELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

LIC809 (FAS) - (06/04)

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