103808065-11-15-2019-04-CC-ROCA-BHXR9K-20191115114939

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103808065
Report Date: 11/15/2019
Date Signed: 11/15/2019 11:49:53 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:	CARUTHERS UNIFIED SCHOOL DIST/FAMILY SERVICE CTR		FACILITY NUMBER:	103808065
ADMINISTRATOR:	GIBSON, NICOLE		FACILITY TYPE:	850
ADDRESS:	10 TILLER		TELEPHONE:	(559) 495-7898
CITY:	CARUTHERS	STATE: CA	ZIP CODE:	93609
CAPACITY:	63	CENSUS: 22	DATE:	11/15/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Nicole Gibson		TIME COMPLETED:	12:05 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	Licensing Program Analysts (LPAs) Ruby Ocegueda and Gloria Reyes made an unannounced Annual inspection. LPAs met with Director, Nicole Gibson.The center is located on the campus of Caruthers Elementary School. This program operates during the traditional school year with an AM and PM session. The morning session is from 8:00 AM to 11:00 AM and the afternoon session is from 12:00 PM to 3:00 PM. This facility has three classrooms (Classroom #1/Blue room, Classroom #2/Yellow room, and Classroom #3/Pink room). Children have exclusive use of the classrooms, restrooms and the outdoor play yard. Breakfast and lunch is prepared and served in the school cafeteria. Children are escorted to the cafeteria. There were no bodies of water. Firearms/weapons are not allowed or stored on premises. All children were under supervision, including visual supervision, of a teacher at all times. The Department has inspection authority. There was a ratio of one teacher supervising no more than 12 children in attendance. Disinfectants, cleaning solutions, and other dangerous items were inaccessible to children. No poisons were observed. All materials and surfaces accessible to children were observed to be toxic free. Currently, there are no children in care being administered medications. All toilets and hand washing facilities were safe and in sanitary operating conditions. All floors were clean and safe. Furniture and equipment were in good condition, free of sharp, loose, or pointed parts. Uncontaminated drinking water was available both indoors and outdoors. Menus were posted at least one week in advance, where an authorized representative can view them, are dated and kept on file for 30 days, and are available on request. Facility had one or more functioning carbon monoxide detectors that meet statutory requirements. Playground equipment is in good condition, free of sharp, loose, or pointed parts. Outdoor activity space surface was inspected. Areas around high climbing equipment, swings, and slides have rubber foam cushioning material to absorb falls. (see next page)

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ruby Ocegueda	TELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019

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: CARUTHERS UNIFIED SCHOOL DIST/FAMILY SERVICE CTR	FACILITY NUMBER: 103808065
	VISIT DATE: 11/15/2019

NARRATIVE

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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. As a condition of employment, all individuals subject to a criminal record review have a clearance or exemption through Caruthers Unified School District. Staff records contain appropriate, documentation of education credits. At least one person trained in Pediatric CPR and Pediatric First Aid is present when children are at the facility or at off-site activities. The person, who signs the child in/out, is responsible for the child, uses their full legal signature and records the time of day. Child's admission agreement is available for review.

Incidental Medical Services (IMS) is not being provided. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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 LPA verified that immunizations have been completed by staff.

Children's files that were inspected today contained all necessary forms and immunization verification. Staff files were inspected and LPA verified required immunizations and all necessary licensing forms. Staff files did not contain Mandated Reporter Training AB1207.

Per California Code of Regulations, Title 22, Division 12, Chapter 1, the following deficiency was cited today (see 809-D).

An exit interview was conducted with Director Nicole Gibson, a copy of this report was provided and discussed.

A Notice of Site Visit Form was posted on parent's board and must remain posted for 30 days

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ruby Ocegueda	TELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: CARUTHERS UNIFIED SCHOOL DIST/FAMILY SERVICE CTR	FACILITY NUMBER: 103808065
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/15/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/13/2019 Section Cited	1 2 3 4 5 6 7	On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and
	8 9 10 11 12 13 14	shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement was not met as evidenced by records review, it was observed that no staff had AB1207. This poses a potential risk to the health, safety, or personal rights of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ruby Ocegueda	TELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019

LIC809 (FAS) - (06/04)

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