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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103801717
Report Date: 05/08/2019
Date Signed: 05/08/2019 02:02:27 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:CHILD DEV. STATE PRESCHOOL CLOVIS ELEMENTARYFACILITY NUMBER:
103801717
ADMINISTRATOR:KIYUNA, CHARLENEFACILITY TYPE:
850
ADDRESS:1100 ARMSTRONGTELEPHONE:
(559) 327-9186
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:30CENSUS: 20DATE:
05/08/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Teacher - Mariana BarnesTIME COMPLETED:
02:10 PM
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An unannounced Annual/Random inspection was conducted today by Licensing Program Analyst (LPA) Luisa Gavoutian. LPA met with Teacher Mariana Barnes and toured the facility, both indoors and outdoors. There are no bodies of water on site. Firearms/weapons are not allowed or stored on premises. 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. Disinfectants, cleaning solutions and other dangerous items are inaccessible to children. LPA discussed the importance of keeping cleaning supplies, adult scissors, staff’s personal belongings, and all items labeled “keep out of reach of children” inaccessible to children in care. No poisons were observed during today’s inspection. All materials and surfaces accessible to children are toxic free. Medications are in a safe place inaccessible to children. All toilets, hand washing, and bathing facilities are in safe and sanitary operating conditions. All floors are clean and safe. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements.

All kitchen, food prep, and storage areas are clean, free of litter, rubbish, and rodents/vermin. All food is protected from contamination, and contaminated food is discarded immediately. Breakfast and lunch are provided by the school cafeteria and children have the option of bringing meals from home. Solid waste storage vessels, including moveable bins, have tight-fitting covers, and are in good repair. Licensee is reminded that all food waste is to be discarded only in waste bins with tight-fitting lids. Uncontaminated drinking water is available indoors through a water cooler and disposable cups stored in a cup dispenser and outdoors through an igloo with disposable cups stored in a cup dispenser. All foods/beverages capable of rapid spoiling are stored in covered containers at 45 (F) or less. Menus are posted at least one week in advance, where an authorized representative can view them. (Continued on next page, LIC-809C)
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa GavoutianTELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
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 DEV. STATE PRESCHOOL CLOVIS ELEMENTARY
FACILITY NUMBER: 103801717
VISIT DATE: 05/08/2019
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Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, the following deficiency is found: (see LIC809-D) Site Visit Notice posted on the parent board. Exit interview was conducted with Teacher Mariana Barnes.

Licensee was provided a copy of appeal rights.

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.

To order forms, etc. please visit our website at www.ccld.ca.gov.
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa GavoutianTELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
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 DEV. STATE PRESCHOOL CLOVIS ELEMENTARY
FACILITY NUMBER: 103801717
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/08/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/15/2019
Section Cited
CCR
101229.1(b)
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Sign In and Sign Out. The person who brings the child to, and removes the child from, the center shall sign the child in/out. This requirement was not met as evidenced by:
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Licensee to train staff and staff to communicate with parents/authorized representatives the importance of signing children in and out. Licensee to submit written statement on how staff will ensure parents/authorized representatives sign children in or out each time.
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Based on records review and interview, children were signed in or out by facility staff when parents/authorized representatives forgot to sign the child in or out during drop off or pick up. This poses a potential risk to the health, safety, or personal rights of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa GavoutianTELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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 DEV. STATE PRESCHOOL CLOVIS ELEMENTARY
FACILITY NUMBER: 103801717
VISIT DATE: 05/08/2019
NARRATIVE
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Playground equipment is in good condition, free of sharp, loose, or pointed parts.
Outdoor activity space surface is maintained in a safe condition and is free of hazards. Licensee is to regularly remove cobwebs from the outdoor play structure, tables and chairs, and other surfaces. Areas around high climbing equipment and slides have cushioning material in the form of wood chips to absorb falls.

CCL shall notify a licensee to immediately terminate the employment of, or to remove/bar any person with specified convictions or for other reasons. The licensee shall comply with the notice. Before working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have a clearance from Clovis Unified School District. Staff records contain appropriate documentation of education credits. At least one person trained in CPR and Pediatric first-aid is present when children are at the facility or at off-site activities. LPA reviewed the sign-in/sign-out sheets and found that children were signed in or out by facility staff when child’s parent/authorized representative forgot to sign the child in or out. Licensee is reminded of the importance of a child’s parent/authorized representative signing the child in or out and recording the time of day. Child's admission agreement is available for review.

This is an AM/PM half day program which operates on a traditional school year schedule. The morning session is 8:00am to 11:00am and the afternoon session is 11:15pm to 2:15pm, Monday through Friday.

Required CCL forms are posted on parent's board.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. (Continued on next page, LIC809-C)
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa GavoutianTELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4