100407359-12-7-2022-04-CC-KVAG-CLVRJX-20221207120441

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 100407359
Report Date: 12/07/2022
Date Signed: 12/07/2022 12:04:53 PM

Document Has Been Signed on 12/07/2022 12:04 PM - It Cannot Be Edited

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:	CHILD DEVELOPMENT-STATE PS-TEMPERANCE-KUTNER		FACILITY NUMBER:	100407359
ADMINISTRATOR:	BLACKBURN, KATHY		FACILITY TYPE:	850
ADDRESS:	1448 N. ARMSTRONG		TELEPHONE:	(559) 456-2081
CITY:	FRESNO	STATE: CA	ZIP CODE:	93727
CAPACITY:	24	CENSUS: 13	DATE:	12/07/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Anatalie Mata-Alcala		TIME COMPLETED:	12:15 PM

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 12/07/2022, Licensing Program Analyst (LPA) Ka Vang, conducted an unannounced Annual Inspection. LPA met with Teacher Director, Anatali Mata-Alcala and Sheresse Roblyer, Associate Teacher. LPA conducted a tour of the facility, indoors and outdoors. This Preschool facility operates on a traditional school year, schedule from August to June from 8:00 a.m. to 11:00 a.m, Monday through Friday. The facility has an operatable. All children are under supervision, including visual supervision, of a teacher at all times. There is a ratio of one teacher supervising no more than 12 children in attendance. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication, and other hazardous items are made inaccessible. No poisons were observed during the inspection. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. During inspection, Anatali stated that Preschool Children shared the restroom with Grade School student. LPA reviewed FAS and facility file; there was no waiver for the shared of restroom. Anatali stated that supervising is being provided when preschool children used the restroom. During inspection, facility submitted a shared restroom waiver request to LPA. LPA explained to Anatali that LPA will take the waiver request to review for approval. A Technical Violation was issued as facility did not have waiver approval for the shared of the restroom. LPA observed and all toilets and handwashing facilities are in safe and sanitary operating condition. All floors are clean and safe. The facility is free of flies, insects and rodents. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. Preschool children eat breakfast in the school cafeteria. Menus are posted at least one week in advance where an authorized representative can view them. All food preparation and storage areas are clean, free of litter/rubbish and rodents/vermin. (Continued on LIC 809-C).

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ka Vang	TELEPHONE: (559) 410-0327
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022

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: CHILD DEVELOPMENT-STATE PS-TEMPERANCE-KUTNER	FACILITY NUMBER: 100407359
	VISIT DATE: 12/07/2022

NARRATIVE

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All food is protected against contamination and any contaminated food is discarded immediately. Solid waste storage containers have tight-fitting covers and are in good repair. Uncontaminated drinking water is available both indoors and outdoors.

Playground equipment is in safe condition, free of sharp, loose, or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. A Technical Assistance was issued as LPA observed the landing areas at the front of first slide in need of additional wood chips to cushion the area when children are sliding down. LPA advised Teacher it is best practice to have designated staff rake and even out the wood chips in the landing area at the front of the slide to provide the cushioning needed.

Before working or volunteering in a licensed childcare facility, all individuals subject to a criminal record review have a clearance or exemption and have been associated to the facility. Capacity and limitations as specified on the license are being maintained. At least one person trained in Pediatric CPR and First Aid is present when children are at the facility or at offsite activities. The name of the childcare center director or fully-qualified teacher(s) designated to act in the director’s absence has been reported to the Department.

The person who signs the child in/out of the facility uses their full legal signature and records the time of day. LPA reviewed a sample of children’s files and observed files were complete with contact information for authorized representatives or others who can assume responsibility if the authorized representative cannot be reached. LPA observed all children’s files contain a medical assessment. LPA reviewed a sample of staff files and observed files were complete with health screening, immunization records for influenza, pertussis, and measles, and current documentation of completed mandated reporter training.

Incidental Medical Services (IMS) currently provided for this class. Child #3 is currently have all documentation and medication in file. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

(Continued on LIC 809-C).

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ka Vang	TELEPHONE: (559) 410-0327
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022

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: CHILD DEVELOPMENT-STATE PS-TEMPERANCE-KUTNER	FACILITY NUMBER: 100407359
	VISIT DATE: 12/07/2022

NARRATIVE

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LPA and Director discussed the CCL website (www.ccld.ca.gov) which provides access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per the California Code of Regulations, Title 22, Division 12, Chapter 1, no deficiency is been cited during today’s inspection.

Facility Representative was provided a copy of appeal rights. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Anatali Mata-Alcala.

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ka Vang	TELEPHONE: (559) 410-0327
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022

LIC809 (FAS) - (06/04)

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