103808837-7-13-2023-57-CC-JPEE-CTPV3L-20230713160454

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103808837
Report Date: 07/13/2023
Date Signed: 07/13/2023 04:05:04 PM

Document Has Been Signed on 07/13/2023 04:05 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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	JEFFERSON STATE PRESCHOOL		FACILITY NUMBER:	103808837
ADMINISTRATOR:	TUPPER, MEGAN		FACILITY TYPE:	850
ADDRESS:	1296 E. WASHINGTON		TELEPHONE:	(559) 305-7237
CITY:	REEDLEY	STATE: CA	ZIP CODE:	93654
CAPACITY:	36	CENSUS: 16	DATE:	07/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Lead Teacher, Carla Douhan		TIME COMPLETED:	04:15 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	On 7/13/2023, Licensing Program Analyst (LPA) Jose Penate conducted an unannounced annual inspection at the facility and met with Lead Teacher, Carla Douhan. A tour of the facility was conducted indoors and outdoors. There were no bodies of water, firearms and/or ammunition on the premises. No poisons were observed during the inspection. Furniture and equipment were in good condition, free of sharp, loose or pointed parts. Playground equipment was in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space was maintained in a safe condition and was free of hazards. Areas around high climbing equipment, swings and slides have cushioning material to absorb falls. Children's toilets and hand washing facilities were sanitary and in good operating conditions. LPA observed floors in the boys and girls restroom to have multiple stains that are releasing a strong scent of urine. Staff stated that they are aware of the issue and a work order has been made but unfortunately the issue has not been corrected. The facility was free of flies, insects, and rodents/vermin. Meals/snacks for the children are delivered from the school district to the facility. All food was protected against contamination and any contaminated food is discarded immediately. Solid waste storage containers had tight-fitting covers and were in good repair. Menus are posted at least one week in advance where an authorized representative can view them. Drinking water was available both indoors and outdoors. The facility had one or more functioning carbon monoxide detectors that met statutory requirements. Capacity and limitations as specified on the license are being maintained. The name of the child care center Director or fully-qualified teacher(s) designated to act in the Director's absence has been reported to the Department. The facility maintains a ratio of one teacher supervising no more than 12 children in care. All children are under supervision, including visual supervision, of a teacher at all times. The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. A sample of children's files were reviewed and contained contact information for authorized representative and/or relatives or others who can assume responsibility for the child and medical assessment. Staff files reviewed and documentation observed including immunization records and current documentation of completed Mandated Reporter Training. 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 LIC809-C

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Jose Penate	TELEPHONE: (559) 341-5860
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023

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
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: JEFFERSON STATE PRESCHOOL	FACILITY NUMBER: 103808837
	VISIT DATE: 07/13/2023

NARRATIVE

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Facility was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption. 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.

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 Family Child Care Homes Section 102417. 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 discussed the Community Care Licensing website www.ccld.ca.gov http://www.ccld.ca.gov/ which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Lead Poisoning Facts, Forms and Regulations.
This facility has two classrooms: classroom 1 operates year-round Monday through Friday 7:30 AM to 5:30 PM; classroom 2 operates on the traditional school year Monday through Friday with AM session from 8:00 AM to 11:00 AM and PM session from 12:30 PM to 3:30 PM.

Per Title 22, Division 12, Chapter 1 of the California Code of Regulations deficiencies cited today (See LIC809-D).

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Lead Teacher, Carla Douhan.

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Jose Penate	TELEPHONE: (559) 341-5860
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/13/2023 04:05 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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: JEFFERSON STATE PRESCHOOL	FACILITY NUMBER: 103808837
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101223(a)(2)

Personal Rights

(a) The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above. During inspection LPA observed stained floors in boys and girls restroom. Due to the stains the restrooms, each area is releasing strong odors of urine. LPA advised licensee that floors would have to be replaced. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/14/2023
	Plan of Correction
1 2 3 4	Replace flooring in boys and girls restrooms by POC date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Duane Matsubara	TELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Jose Penate	TELEPHONE: (559) 341-5860
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023

LIC809 (FAS) - (06/04)

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