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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100408796
Report Date: 06/16/2020
Date Signed: 06/17/2020 10:34:12 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:MENDOTA MIGRANT HEAD STARTFACILITY NUMBER:
100408796
ADMINISTRATOR:PEREZ, ARACELIFACILITY TYPE:
850
ADDRESS:435 SORENSEN AVENUETELEPHONE:
(559) 655-3087
CITY:MENDOTASTATE: CAZIP CODE:
93640
CAPACITY:30CENSUS: 0DATE:
06/16/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Araceli PerezTIME COMPLETED:
11:30 AM
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On 06/16/2020, Licensing Program Analyst Juvenal Moctezuma conducted an unannounced Case Management inspection and met with Center Director, Araceli Perez and toured the facility both inside and outside. Licensee is decreasing their preschool capacity from 30 to 23 preschool children.

This program operates seasonal from June to October, daily from 7:00 AM to 3:00 PM. Breakfast, lunch, and snacks will be provided and prepared on site. There is a door leading to the kitchen and Araceli stated that the door will remain closed and locked at all times during Day-care hours. There is a sink with hot water inside kitchen for food preparation. Ill children and staff will utilize the bathroom located outside the classrooms. Ill children will be isolated in break room area located next to the office. Room measurements taken and reviewed with Araceli Perez. Classroom A and Classroom B will be used by preschool children and the combined total preschool square footage is 826 which will accommodate the 23 preschool children.

Adequate storage space available for children's belongings. Outdoor storage is available for toys and equipment. Licensee has two locked sheds for outdoor storage. Toys and equipment are age appropriate.

Outdoor measurements were not taken during today's visit. Licensee is decreasing capacity. Adequate shade is available in the outdoor activity area. The applicant is using wood chips for cushioning under the outdoor climbing structures.

There are 2 toilets and 2 sinks/hand washing fixtures in the children's bathroom which will accommodate the requested capacity of 23 preschool children. Licensee is utilizing a water dispenser with disposable cups. Licensee is utilizing an igloo with plastic cups for the outside drinking water.

The fire clearance has been received and approved for 23 preschool children on 06/09/2020. Licensee is providing Incidental Medical Services at this facility.

CONTINUED ON FOLLOWING PAGE

SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2020
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: MENDOTA MIGRANT HEAD START
FACILITY NUMBER: 100408796
VISIT DATE: 06/16/2020
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Pending a final file review, the new license will reflect the decrease of the preschool capacity from 30 to 23 preschool children.
No deficiencies cited during today's visit.
THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.

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

To order forms, etc. visit our website at www.ccld.ca.gov.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2020
LIC809 (FAS) - (06/04)
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