103808951-6-7-2022-04-CC-LGAN-CF6UQ4-20220607154632

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103808951
Report Date: 06/07/2022
Date Signed: 06/07/2022 03:47:03 PM

Document Has Been Signed on 06/07/2022 03:47 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	STONE SOUP FRESNO		FACILITY NUMBER:	103808951
ADMINISTRATOR:	XIONG, YER		FACILITY TYPE:	850
ADDRESS:	1343 E BULLDOG LN		TELEPHONE:	(559) 224-7613
CITY:	FRESNO	STATE: CA	ZIP CODE:	93710
CAPACITY: 96	TOTAL ENROLLED CHILDREN: 92	CENSUS: 63	DATE:	06/07/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Operations Manager - Ka Her		TIME COMPLETED:	04:00 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 06/07/2022, Licensing Program Analyst (LPA) Luisa Gavoutian, conducted an unannounced Annual Inspection. LPA met with Operations Manager Ka Her, who accompanied LPA on a tour of the facility, indoors and outdoors. This facility maintains a waiver for shared outdoor play area at staggered times. Hours of operation are Monday – Friday, 7:00 a.m. – 5:30 p.m. All children were under supervision, including visual supervision, during the initial tour of the facility. At approximately 1:50 p.m., LPA toured the classrooms once again to observe nap time procedures. LPA observed the following: in Room 1, Staff 4 was seated at the computer at the teacher's cubicle and did not have visual observation of the napping children; in Room 2, LPA observed Staff 5 was occupied in the teacher's cubicle and did not have visual observation of the napping children; in Room 4, LPA observed Staff 6 seated at one of the tables in the classroom working on a laptop. Furthermore, LPA observed in each classroom, Room 1, Room 2, Room 3, and Room 4, that the positioning of the staff did not allow for constant visual supervision of all napping children, particularly those whose cots were placed behind large furniture items, such as book shelves. In Room 4, LPA observed a small puddle near a napping child's cot and brought it to Staff 6's attention, and Staff 6 determined that the child had an accident and tended to the child's needs. There is a ratio of one teacher supervising no more than 12 children in attendance. There is no swimming pool or other bodies of water on the premises. There is a small fish tank in Room 2 equipped with a lid. There are no firearms or ammunition allowed or stored on the premises. LPA observed the following: one bottle of hand sanitizer accessible on a shelf in Room 1; five containers of Clorox disinfectant wipes, one container of Lysol disinfectant wipes, three packs of other disinfectant wipes, and two bottles of hand sanitizer in a supply closet in the accessible teacher's cubicle area in Room 2; one container of Clorox disinfectant wipes in the accessible staff office with access from Room 2 and Room 3; one bottle of hand sanitizer accessible on a shelf in Room 4. (Continued on LIC 809-C)

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Luisa Gavoutian
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

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 06/07/2022 03:47 PM - It Cannot Be Edited

Created By: Luisa Gavoutian On 06/07/2022 at 02:36 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: STONE SOUP FRESNO	FACILITY NUMBER: 103808951
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/07/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101229(a)(1)

Responsibility for Providing Care and Supervision

(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. 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 in that staff failed to provide constant visual observation of napping children as described in LIC 809 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/21/2022
	Plan of Correction
1 2 3 4	Facility representative stated that a staff meeting will be conducted to train staff on proper nap time supervision of children; facility representative shall submit a copy of the meeting agenda and signatures of attendees to CCL by 06/21/2022.

Type B

Section Cited

CCR

101217(a)

Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in two staff did not have a personnel file which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/07/2022
	Plan of Correction
1 2 3 4	Facility representative stated that complete personnel records will be obtained and maintained for the two staff. Facility representative shall submit copies of the two personnel files to CCL by 07/07/2022.

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 Moctezuma

LICENSING EVALUATOR NAME:

Luisa Gavoutian

LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: STONE SOUP FRESNO	FACILITY NUMBER: 103808951
	VISIT DATE: 06/07/2022

NARRATIVE

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Facility staff removed all items during today's inspection and made them inaccessible to children. Facility representative was reminded that all cleaning supplies, disinfectants, and items labeled "keep out of reach of children" shall be stored where they are inaccessible to children. Furthermore, LPA advised that children are allowed to use hand sanitizer, but only under the supervision of an adult and hand sanitizer must be kept out of reach of children. No poisons were observed during the inspection.

Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. All toilets and handwashing facilities are in safe and sanitary operating condition. LPA observed the edges of the multicolored squares rug and the tan rug in Room 3 were unravelling. The facility is free of flies, insects and rodents. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements.

This facility orders catered breakfast and lunch from an external vendor and provides AM/PM snacks. All kitchen, food preparation, and storage areas are clean, free of litter/rubbish and rodents/vermin. All food is protected against contamination and any contaminated food is discarded immediately. Solid waste storage containers have tight-fitting covers and are in good repair. Uncontaminated drinking water is available both indoors and outdoors. Menus are posted at least one week in advance where an authorized representative can view them.

Playground equipment is in safe condition, free of sharp, loose, or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. Areas around high climbing equipment, and slides have cushioning material in the form of wood chips to absorb falls.

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.
(Continued on LIC 809-C)

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Luisa Gavoutian
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: STONE SOUP FRESNO	FACILITY NUMBER: 103808951
	VISIT DATE: 06/07/2022

NARRATIVE

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Capacity and limitations as specified on the license are being maintained. At least one person trained in Pediatric CPR and First Aid is present when children are at the facility or at offsite activities. The person who signs the child in/out of the facility uses their full legal signature and records the time of day. LPA reviewed a sample of children’s files and observed files were complete with contact information for authorized representatives or others who can assume responsibility if the authorized representative cannot be reached. LPA observed that all children’s files contained a medical assessment. LPA reviewed staff files and observed files were complete with health screening, immunization records for influenza, pertussis, and measles, and current documentation of completed mandated reporter training. LPA found Staff 1 and Staff 2 did not have a personnel file although they each assist with the preschool program. Facility representative stated that the facility Director, Yer Xiong, has not been with the facility since March 2020. The Director who succeeded Yer Xiong, Yer Thao, has left the position at the end of May 2022, and the facility is currently in the process of hiring a new Director.

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. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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 and facility representative discussed the Community Care Licensing (CCL) website (www.ccld.ca.gov) which provides access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Lead Poisoning Facts, Forms and Regulations.

Per Chapter 1, Division 12, Title 22 of the California Code of Regulations, the following deficiencies were found: (see LIC809-D). Exit interview was conducted and report was reviewed with the facility representative Ka Her.

(Continued on LIC 809-C)

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Luisa Gavoutian
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: STONE SOUP FRESNO	FACILITY NUMBER: 103808951
	VISIT DATE: 06/07/2022

NARRATIVE

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A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

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.

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Luisa Gavoutian
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

LIC809 (FAS) - (06/04)

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