103801670-11-30-2020-04-CC-JMOA-BVUVAX-20201130151637

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103801670
Report Date: 11/18/2020
Date Signed: 11/30/2020 03:16:41 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:	FUSD-COLUMBIA		FACILITY NUMBER:	103801670
ADMINISTRATOR:	MATHIES, DEANNA		FACILITY TYPE:	850
ADDRESS:	1025 S. TRINITY		TELEPHONE:	(559) 456-3685
CITY:	FRESNO	STATE: CA	ZIP CODE:	93706
CAPACITY:	22	CENSUS: 0	DATE:	11/18/2020
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Kim Beckwith		TIME COMPLETED:	04:00 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 11/18/2020, Licensing Program Analysts (LPAs) Juvenal Moctezuma & Jeovanna Yanez, conducted an announced inspection visit. LPAs met with Teacher on Special Assignment (TSA), Kim Beckwith. The purpose of this visit was to review the room that licensee, Fresno Unified School District, wishes to open. Licensee would like to move from classroom #18 to classroom #2. Licensee has a capacity of 22 preschool children. Per Title 22 requirements, 101239 (h) Fixtures, Furniture, Equipment and Supplies, states that based upon total licensed capacity, there are to be 15 children for each toilet and sink. Currently, licensed room is #18 which has 2 toilets and 2 sinks. Classroom #2 has one toilet and one sink in the restroom, that is located in the classroom. Kim asked LPA if they could use the bathroom located in the not Licensed classroom #1. LPA notified Kim that he would check with management since there are children in that classroom. There is a school age restroom located down the hallway from classroom #2. Kim stated that if the program cannot use the other toilet and sink located in classroom #1, she could designate a stall and sink in the girls bathroom for the preschool children in classroom #2. A restroom waiver would be required to utilize the school age restroom and/or the bathroom in classroom #1. Licensee would need to send in a waiver request with licensee's protocol to ensure no commingling between school age and preschool children in the restroom, how the required staff to child ratio will be maintained and how 100% supervision will be provided to preschool children while using the school age restroom. Licensee may be required to label one bathroom stall for preschool children only in the school age children restroom. CONTINUED ON FOLLOWING PAGE

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Juvenal Moctezuma	TELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2020

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: FUSD-COLUMBIA	FACILITY NUMBER: 103801670
	VISIT DATE: 11/18/2020

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Licensee will inform Fresno Regional Child Care Office when the licensee will move forward with the classroom change bathroom waiver request.

Per California Code of Regulations Title 22, Division 12, no deficiency to be cited. Exit interview conducted with TSA, Kim Beckwith. 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.

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 print forms, etc. visit our website at www.ccld.ca.gov

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Juvenal Moctezuma	TELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2020

LIC809 (FAS) - (06/04)

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