103808815-10-17-2019-04-CC-JMOA-BH32HB-20191017172427

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103808815
Report Date: 10/17/2019
Date Signed: 10/17/2019 05:24:32 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:	ST. AGNES CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	103808815
ADMINISTRATOR:	PRICE, MARYELLEN		FACILITY TYPE:	830
ADDRESS:	1255 E. HERNDON AVE.		TELEPHONE:	(559) 450-3545
CITY:	FRESNO	STATE: CA	ZIP CODE:	93720
CAPACITY:	40	CENSUS: 28	DATE:	10/17/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Maryellen Price		TIME COMPLETED:	05:35 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 Analyst (LPA) Juvenal Moctezuma conducted an unannounced Annual/Random Inspection and met with Site Supervisor, Maryellen Price. The purpose of the inspection was discussed with Maryellen and a tour of the center was conducted both inside and outside. LPA observed a total of 28 infants in designated classrooms being supervised by teachers. Center operates year round from 6:00am to 6:30pm Monday thru Friday. The napping equipment meets regulation requirements. The sheets and infant sleep sacks are washed everyday. The changing table meets regulation requirements and was placed next to a sink for hand washing. The refrigerator inside each room contains each child's individual food/formula labeled. Maryellen stated that there are currently no infants taking any medications (medications would be stored in a locked cabinet inside each classroom). Furniture, toys and equipment were observed to be clean and in good repair. LPA observed areas were observed to be free of hazards. There is water available for the infants (individual sippy cups). Maryellen stated there are no guns/weapons at the center. LPA did not observe any bodies of water on the property. Playground equipment observed to be safe and free of hazards. LPA reminded licensee to make sure she checks the outdoor play area before infants go outside and play. The infants' Needs/Services plans and individual feeding plans were reviewed. Maryellen stated that the infant needs and services get updated every three months or unless the feeding plan changes. At least one teacher is current with their CPR/FIRST AID. Parent Sign in / sign out sheet was reviewed. LPA reminded licensee to review the sign in and sign out sheet everyday and make sure parents are signing their infants in every day. A sampling of infants files were reviewed and everything was completed. Staff records reviewed contain appropriate documentation of education credits. All staff have a criminal record clearance. Report Continued on LIC 809- C and LIC 809- D

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal Moctezuma	TELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019

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: ST. AGNES CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 103808815
	VISIT DATE: 10/17/2019

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Reviewed Safe Sleep Guidelines with Maryellen Price and provided her with a brochure regarding safe sleep and new lead guidelines. LPAs reminded licensee that there are no toys, blankets, or any other objects allowed inside a crib. Licensee understood and stated that she will read and comply with the regulations once they take affect.

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

During today's inspection the center is in compliance of Title 22 Division 12 and Health and Safety Regulations. No deficiencies were observed.

LPA observed licensee post the Notice of Site visit.
FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal Moctezuma	TELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019

LIC809 (FAS) - (06/04)

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