103808640-9-10-2019-04-CC-CROZ-BFVQT4-20190910122631

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103808640
Report Date: 09/10/2019
Date Signed: 09/10/2019 12:26:41 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:	OUR LADY OF PERPETUAL HELP SCHOOL		FACILITY NUMBER:	103808640
ADMINISTRATOR:	ORTIZ, MARTHA		FACILITY TYPE:	850
ADDRESS:	836 DEWITT AVENUE		TELEPHONE:	(559) 299-7504
CITY:	CLOVIS	STATE: CA	ZIP CODE:	93612
CAPACITY:	26	CENSUS: 13	DATE:	09/10/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Nara Adjemian		TIME COMPLETED:	12:45 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	An unannounced Annual inspection was conducted today by Licensing Program Analysts (LPAs) Candis Rodriguez and Juvenal Moctezuma. LPA met with Director Nara Adjemian and Site Administrator Patrick Dodd 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. No poisons were observed during today’s visit. 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. Snack menus are posted at least one week in advance, where an authorized representative can view them. Facility has 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 is maintained in a safe condition and is free of hazards. Areas around high climbing equipment, swings, and slides have rubber cushioning material 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 or exemption and have been associated to the facility. 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. (Continued on LIC 809-C)

SUPERVISOR'S NAME: Alice Juarez	TELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis Rodriguez	TELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2019

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: OUR LADY OF PERPETUAL HELP SCHOOL	FACILITY NUMBER: 103808640
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/10/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/08/2019 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 shall complete renewal
	8 9 10 11 12 13 14	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 LPAs observation of missing training certificate in one personnel file. This poses a potential risk to the health, safety, and 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: Alice Juarez	TELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis Rodriguez	TELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2019

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: OUR LADY OF PERPETUAL HELP SCHOOL	FACILITY NUMBER: 103808640
	VISIT DATE: 09/10/2019

NARRATIVE

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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.

Upon review of personnel files, LPAs observed a required Mandated Reporter Training certificate missing from one personnel file.

This is a full day program which operates on a traditional school year schedule from 7:00AM to 6:00PM, Monday through Friday.

Required CCL forms are posted on parent's board.

This facility does not provide Incidental Medical Services – IMS at this time. The following information regarding Americans with Disability Act (ADA) was provided: US Department of Justice toll free ADA Information line at (800) 514-0301(voice) and (800) 514-0383 (TDD) and website link
https://www.ada.gov/childqanda.htm for Commonly Asked Questions about Child Care Centers and the ADA.

Per Chapter 1, Division 12, Title 22 of the California Code of Regulations, the following deficiencies are found: (see LIC809-D). Site Visit Notice posted on the parent board.

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.

SUPERVISOR'S NAME: Alice Juarez	TELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis Rodriguez	TELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2019

LIC809 (FAS) - (06/04)

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