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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103808065
Report Date: 08/19/2021
Date Signed: 08/19/2021 02:18:40 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:CARUTHERS UNIFIED SCHOOL DIST/FAMILY SERVICE CTRFACILITY NUMBER:
103808065
ADMINISTRATOR:GIBSON, NICOLEFACILITY TYPE:
850
ADDRESS:10 TILLERTELEPHONE:
(559) 495-7898
CITY:CARUTHERSSTATE: CAZIP CODE:
93609
CAPACITY:63CENSUS: 15DATE:
08/19/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Deanna BergenTIME COMPLETED:
02:35 PM
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On 8/19/2021, Licensing Program Analyst (LPA) Ruby Ocegueda conducted an unannounced Annual Required Inspection for the preschool license. LPA met with lead teacher Deanna Bergen and toured the facility indoors and outdoors as shown on the facility sketch. There is a total of three classroom and two restrooms and play yard in this facility. A covid-19 screening was conducted before entering the facility today. Days and hours of operation are Monday through Friday 8:00 AM 11:00 AM and 12:00 PM to 3:00 PM. This facility follows the traditional yearly school schedule.

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.

Upon inspection of the accessible play yard, LPA observed several small and large red ants near and inside the uncovered sand box. LPA also observed approximately 6-8 holes in the cushioning under the play ground that were approximately 4-8 inches all around. One of the holes was near a metal handle bar on the playground.

Furniture inside the classrooms are in good condition, free of sharp, loose or pointed parts. All toilets and handwashing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe. The school obtains meals from the Caruthers Elementary School and are then individually served to the children in care. No food is prepared ore stored on site. All food is protected against contamination and any contaminated food is discarded immediately. Drinking water is available both indoors and outdoors. Areas around high climbing equipment, swings and slides have cushioning material to absorb falls. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have received a criminal record clearance or exemption. Report continued on 809-C

SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ruby OceguedaTELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021
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 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
VISIT DATE: 08/19/2021
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Upon notification from the Department, the licensee will comply and act immediately to terminate the employment of, remove from the facility or bar from entering the facility for any person it is deemed necessary while the Department considers granting or denying an exemption. Capacity and limitations as specified on the license are being maintained. At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at offsite activities. All staff took training on 8/4/2021, CPR expires on 8/4/2023. The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. All children are under supervision, including visual supervision, of a teacher at all times. Facility maintains a ratio of one teacher supervising no more than 12 children in care. LPA reviewed a sample of children’s files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child and medical assessment. LPA reviewed a sample of staff files and observed files were complete with immunization records for pertussis and measles and current documentation of completed mandated reporter training. Staff #1 was missing health screening, but suspects it could be at the district office, staff #1 will place in the facility file. Menus were not posted today, however lead teacher Bergen stated that the district had notified her the menus would be sent this week due to a change in menus.

Incidental Medical Services (IMS) are not currently being provided. 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.



LPA and lead teacher Bergen discussed the Community Care Licensing website www.ccld.ca.gov which will provide 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 Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiencies are being cited: (see next page, 809 D) Lead teacher Bergen was provided a copy of their appeal rights.

An exit interview was conducted with lead teacher Deanna Bergen. This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ruby OceguedaTELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021
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: 08/19/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/16/2021
Section Cited

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Buildings and Grounds. The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.This requirement was not met as evidenced by: observation. During inspection of the accessible play yard, LPA observed
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approximately 6-8 holes ranging in size from 4-8 inches all around causing tripping hazards. This poses a potential risk to the health, safety and or personal rights to the children in care.
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Type B
09/16/2021
Section Cited

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Buildings and Grounds. (1) The licensee shall take measures to keep the center free of flies, other insects, and rodents.This requirement was not me as evidenced by: observation. During the inspection of the accessible play yard, LPA observed many small and larger red ants near and inside the sand box.
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This poses a potential risk to the health, safety and or personal rights to the 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: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ruby OceguedaTELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:
DATE: 08/19/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/19/2021
LIC809 (FAS) - (06/04)
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