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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103808143
Report Date: 09/13/2022
Date Signed: 09/13/2022 01:20:23 PM


Document Has Been Signed on 09/13/2022 01:20 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:MADISON ELEMENTARYFACILITY NUMBER:
103808143
ADMINISTRATOR:WENDY HERNANDEZFACILITY TYPE:
850
ADDRESS:330 S. BRAWLEYTELEPHONE:
(559) 276-5280
CITY:FRESNOSTATE: CAZIP CODE:
93706
CAPACITY:24CENSUS: 19DATE:
09/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Roxanna QuinterosTIME COMPLETED:
02:00 PM
NARRATIVE
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On 9/13/22 an unannounced annual inspection was conducted today by Licensing Program Analyst, (LPA) Caroline Harris. LPA met with Site Supervisor, Roxanna Quinteros and toured the facility, both indoors and outdoors. The LPA observed required licensing forms to be posted but some were not visible as they were covered. A census was taken and there were nineteen day care children present. This facility runs two half day programs. The AM session is from 8:30AM to 11:30AM and PM session is from 12:30 PM to 3:30 PM. Lunch and snacks are provided, and meals are brought in from the school kitchen and are eaten in the classroom. Menus are posted at least one week in advance, where an authorized representative can view them. Firearms/weapons or ammunition are not allowed or stored on the 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. There were no poisons observed on the premises accessible to children. Licensee is aware that poisons are required to be locked and inaccessible to children. All materials and surfaces accessible to children are toxic free. All toilets, hand washing, and bathing facilities are in safe and sanitary operating conditions. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. There is a working fire extinguisher, smoke detector, carbon monoxide indicator, and adequate heating and ventilation for safety and comfort. The licensee has a complete first aid kit, including bandages, scissor, thermometer, gloves and a first aid manual. Uncontaminated drinking water is available both indoors and outdoors. Playground equipment is in good condition, free of sharp, loose, or pointed parts. Areas around high climbing equipment, swings, and slides have cushioning material to absorb falls. There were no bodies of water on site.
SUPERVISOR'S NAME: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Caroline HarrisTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2022
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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Document Has Been Signed on 09/13/2022 01:20 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: MADISON ELEMENTARY
FACILITY NUMBER: 103808143

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101174(d)
Disaster and Mass Casualty Plan
(d) Disaster drills shall be conducted at least every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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The last fire drill that was logged was on 3/9/22. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/20/2022
Plan of Correction
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The staff agree to conduct a fire drill and log it by the due date of 9/20/22.
Type B
Section Cited
CCR
101238(g)
Buildings and Grounds
(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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During the inspection, the LPA observed sharp scissors and sharpie pens to be down low and accessible to children in three different locations in the classroom. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/13/2022
Plan of Correction
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The pointed scissors and sharpie markers were moved during the inspection.

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: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Caroline HarrisTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/13/2022 01:20 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: MADISON ELEMENTARY
FACILITY NUMBER: 103808143

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238.2(g)
Outdoor Activity Space
(g) The playground shall be enclosed by a fence to protect children and to keep them in the outdoor activity area. The fence shall be at least four feet high.

This requirement is not met as evidenced by:
Deficient Practice Statement
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The LPA observed two of the gates in the playground to have gaps and not closed properly. Also there was an opening between the back of the shed and the fencing where a person could get behind. Lastly, there was an area at the bottom of the fencing that was coming apart, exposing sharp edges and holes. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/27/2022
Plan of Correction
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A work order was put in to have the fencing secured and fixed or replaced in areas noted. A return visit will take place in order to clear this deficiency.
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as one of the teachers did not have proof of MMR and T Dap. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/27/2022
Plan of Correction
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The staff agrees to get copies of the required immunizations by the review date of 9/27/22. A return visit will take place in order to clear this deficiency.

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: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Caroline HarrisTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/13/2022 01:20 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: MADISON ELEMENTARY
FACILITY NUMBER: 103808143

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101212(b)
Reporting Requirements
(b) The name of the child care center director, and any fully qualified teacher(s) designated to act in the child care center director's absence, shall be reported to the Department within 10 days of a change of child care center director or designee(s).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as the director had changed but the Fresno CCL office was not notified. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/27/2022
Plan of Correction
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The new center director was given a print out of what is required to be submitted for her directors packet. The new director agrees to submit the required documents and information by the due date of 9/27/22.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Caroline HarrisTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2022
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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: MADISON ELEMENTARY
FACILITY NUMBER: 103808143
VISIT DATE: 09/13/2022
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The facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. There are no excluded individuals present at this facility. Licensee is aware that upon notice from the Department, any excluded individual must be immediately removed from the facility and prevented from returning to the center or having contact with children in care. The licensee shall comply with the notice. Staff records contain appropriate, documentation of education credits. At least one person is to be trained in CPR and Pediatric first-aid and shall be present when children are at the facility or at off-site activities. This facility does have one person trained in CPR and first aid. LPA reviewed the Mandated Child Abuse Reporter Training (AB 1207), which all staff have completed. It is required to be updated every two years. The LPA and licensee discussed the Community Care Licensing website: www.ccld.ca.gov. which provides access to Provider Information Notifications (PINS), Quarterly Updates that inform licensees of new legislation and regulations, training's, and Licensing forms and updated information. The licensee was also advised that it is her responsibility to stay current with regulations. 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. The LPA reviewed six children’s files. All required licensing documents were observed in each of the children’s files. Licensee also maintains documentation of immunizations for the children. Incidental Medical Services (IMS) policy was discussed. This facility provides Incidental Medical Services (IMS). LPA reviewed the storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. Medications are stored in a safe place inaccessible to children.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiencies are found: (see LIC809-D). An exit interview was conducted and a copy of this report (along with appeal rights) was provided and reviewed with Roxanna Quinteros. This report shall be made available to the public upon request. The LIC 9213 Notice Of Site Visit form was given to Mrs. Quinteros and must remain posted for 30 days.



To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process
SUPERVISOR'S NAME: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Caroline HarrisTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022
LIC809 (FAS) - (06/04)
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