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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153808258
Report Date: 05/21/2019
Date Signed: 05/21/2019 11:42:14 AM

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:COUNTRY CHRISTIAN SCHOOL, INCFACILITY NUMBER:
153808258
ADMINISTRATOR:MERRIMAN, ROSEFACILITY TYPE:
840
ADDRESS:2416 DEAN AVENUETELEPHONE:
(661) 589-4703
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:60CENSUS: 0DATE:
05/21/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Rose Merriman- Director TIME COMPLETED:
11:50 AM
NARRATIVE
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Licensing Program Analyst (LPA) Jessika Thompson conducted an unannounced annual/random inspection. LPA met with Director Rose Merriman. This is a summer program that operates during the months of June and July and August, from 6:45 AM to 5:30 PM, yearly. Afternoon snack is provided to children in care. A tour of the facility, inside and outside, as shown on the facility sketch was conducted. There are no bodies of water, firearms and/or ammunition on the premises. Hazardous items and medications are inaccessible to children. Furniture, equipment and materials are sufficient, age appropriate, in good repair and toxic free. The playground equipment and outdoor activity space is maintained and in good condition, free of hazards with adequate cushioning material. Children's toilets and hand washing facilities are sanitary and in good operating condition. Rooms and floors are safe and clean. Food preparation area is clean and free of rodent and other vermin. Contaminated food is discarded immediately, when applicable. Storage containers for solid waste are in good repair with tight-fitting covers. Sanitary drinking water is available both indoors and outdoors. The licensee is taking measures to keep the facility free of insects, rodents, etc. No excluded adults are present at the facility. Conditions, limitations and capacity specified on license are in compliance. Staff requiring criminal record clearance or exemptions are associated to the facility as indicated on LIS 555 – Facility Roster. First Aid/CPR reviewed and in compliance. Qualified staff designated to act in the Director’s absence has been reported accordingly. Director is aware that Sign In/Sign Out sheets must have full legal signature and time of day. Menus are posted. A sample of children's and staff’s records reviewed and are in compliance. Children’s records include consent for emergency medical treatment. Staff records contain required documented health screening. Lead safety information was provided to Director Merriman. Director Merriman understands that this information is also required to be provided to parents and/or authorized representatives of children in care.

(Continued on LIC809-C)
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika ThompsonTELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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: COUNTRY CHRISTIAN SCHOOL, INC
FACILITY NUMBER: 153808258
VISIT DATE: 05/21/2019
NARRATIVE
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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 California Code of Regulations, Title 22, Division 12, the following deficiencies are found: (see LIC809-D)

In exit interview the licensee was advised of appeals rights and was provided with Appeals Rights.
LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika ThompsonTELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: COUNTRY CHRISTIAN SCHOOL, INC
FACILITY NUMBER: 153808258
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/23/2019
Section Cited
CCR
1596.954
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Health & Safety. Carbon monoxide detectors required: Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section
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Licensee will purchase a carbon monoxide detector and submit copy of receipt and photo of installed carbon monoxide detector to Fresno Regional Office by 05/23/19.
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13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections. This requirement was not met, as currently, this facility does not have a carbon monoxide detector. This poses a potential risk to children in care.
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Type B
06/21/2019
Section Cited
CCR
1596.7995(a)(1)
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Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and
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Licensee will send proof of the required immunization for herself, and all staff members that have direct contact with children in care, to the Fresno Community Care Licensing office by 06/21/19.
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volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement was not met, as evidenced by records review conducted by LPA. Today, during records review, the licensee was unable to provide proof of influenza, pertussis, and measles immunization for facility staff. This poses a potential Health and Safety risk to children in care.

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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: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika ThompsonTELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019
LIC809 (FAS) - (06/04)
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