103810072-8-8-2019-04-CC-CBRN-BEUTJE-20190808144614

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103810072
Report Date: 08/08/2019
Date Signed: 08/08/2019 02:46:23 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:	MENDOTA U.P.S./MENDOTA U.S.D.		FACILITY NUMBER:	103810072
ADMINISTRATOR:	PEREZ, ARACELI		FACILITY TYPE:	850
ADDRESS:	195 SMOOT AVE		TELEPHONE:	(559) 655-1191
CITY:	MENDOTA	STATE: CA	ZIP CODE:	93640
CAPACITY:	48	CENSUS: 0	DATE:	08/08/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Araceli Perez		TIME COMPLETED:	03:15 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	A prelicensing inspection visit was conducted on this date by Licensing Program Analyst (LPA) Cynthia Brannon, who met with Preschool Director, Araceli Perez. The licensee is requesting the following capacity of 48 preschool children. This program will operate traditional school year. This facility has an AM and PM sessions. The AM session is from 8:00 AM to 11:00 AM, and the PM session is from 11:30 AM to 2:30 PM; Monday thru Friday. Currently, the meals are prepared off-site at Mendota High School cafeteria. For the AM session, breakfast and lunch will be provided. For the PM session, lunch and a snack will be provided. At this time, the kitchen on site is not used. Ill children and staff will utilize the bathroom located in each classroom. Ill children will be isolated in director's office. Room measurements taken and reviewed with center director, Araceli Perez. There are 3 classrooms that will be used by preschool children. There is multi-purpose room that will be used for meals. The total preschool square footage is 2861 which will accommodate the requested capacity of 48 preschool children. Adequate storage space available for children's belongings. CONTINUED ON FOLLOWING PAGE

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia Brannon	TELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019

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: MENDOTA U.P.S./MENDOTA U.S.D.	FACILITY NUMBER: 103810072
	VISIT DATE: 08/08/2019

NARRATIVE

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Outdoor storage is available for toys and equipment. Currently, there are two locked sheds in the area that is not accessible to preschool children. Outdoor measurements taken on this date total 9769 square feet which will accommodate the requested capacity of 48. Adequate shade is available in the outdoor activity area. Licensee installed two shade structures; one in each play yard. The shade structure poles are cushioned to help prevent a child from receiving an injury when running into the poles. There are two outdoor play areas. One area is in front of classrooms #1 and #2. The other outdoor play yard is in front of classroom #3. The play yard in front of classrooms #1 and #2 have a climbing structure. This structure has an enclosed slide. Per center director, staff will position themselves in front of the slide to provide visual observation. In the other play yard, the climbing structure is in the shape of a train, which has a tunnel in front. Per center director, staff will be position in front of tunnel to provide visual observation when children are utilizing this component. The applicant is using artificial turf for cushioning under the outdoor climbing structure. Licensee is utilizing igloos with disposable cups and cup dispenser for outdoor drinking water. There are water fountains and sink outside.

There are a total of six toilets and three sinks/hand washing fixtures in the children's bathrooms, and four toilets and four sinks/hand washing fixtures in the multipurpose room, which will accommodate the requested capacity of 48 preschool children. Licensee is utilizing water dispensers with disposable cups and cup dispenser in each classroom.

CONTINUED ON FOLLOWING PAGE

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia Brannon	TELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019

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: MENDOTA U.P.S./MENDOTA U.S.D.	FACILITY NUMBER: 103810072
	VISIT DATE: 08/08/2019

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The fire clearance has been received and approved for 48 preschool children.

Incidental Medical Services (IMS) policy was discussed. 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 Per center director, Araceli Perez, there are no children requiring IMS at this time.

The following items must be completed prior to issuing a license by:

1. Licensee shall provide the manufacturer's specifications for the cushioning and artificial turf.
Pending a final file review and completion of above item, a recommendation will be made to license the above facility for a capacity of 48 preschool children.

The following documents should be posted at the facility:
* PUB 269- Child passenger restraint systems poster 101225(f) Transportation
* Pub 393- Notification of Parents Rights 101218.1(c) Admission Procedures
* License 101160(a) License
* Menus 101227(a)(6) Food Services
* LIC 613A- Personal Rights form 101223(b)(2) Personal Rights
* LIC 610- Disaster Plan 101174(a)
* LIC 9148- Earthquake Preparedness Checklist 101174(b)

To order forms, etc. visit our website at www.ccld.ca.gov.

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia Brannon	TELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019

LIC809 (FAS) - (06/04)

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