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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153808447
Report Date: 06/01/2023
Date Signed: 06/01/2023 02:22:24 PM


Document Has Been Signed on 06/01/2023 02:22 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:A GOOD TIME OUTFACILITY NUMBER:
153808447
ADMINISTRATOR:MELANIE SHERMANFACILITY TYPE:
830
ADDRESS:3400 CALLOWAY DRIVE, SUITE 502TELEPHONE:
(661) 410-8463
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:17CENSUS: 9DATE:
06/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Amy BennettTIME COMPLETED:
02:30 PM
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On 6/1/2023, Licensing Program Analyst (LPA) Theresa Marquez conducted an unannounced annual inspection for a Good Time Out infant program. LPA met with Director, Amy Bennett, and toured the facility, indoors and outdoors.
A Good Time Out infant program is a part-time and full day program operating year round, 6:30 AM – 6:00 PM, Monday – Friday. The center provides AM/PM snacks and lunch.

Capacity and limitations as specified on the license are being maintained. The name of the childcare 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 4 infants 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.
The facility had sufficient age appropriate furniture and equipment, including cribs, cots or mats, changing tables, and feeding chairs. Each crib, mat, or cot was occupied by only one infant at a time and cribs were free from all loose articles including blankets and pillows. There were no objects hanging above or attached to the crib. Infants are not swaddled in care. For infants up to 12 months, documentation also includes sleeping position if it is other than on their back. Individual Infant Sleeping Plans were completed and in file for each infant up to 12 months of age.. Staff-infant ratio requirements were being met while infants were sleeping. There was indoor and outdoor activity space for infants that was physically separate.
There were no bodies of water, firearms and/or ammunition on the premises. Disinfectants and hazardous items were inaccessible to children. Furniture and equipment were in good condition, free of sharp, loose or pointed parts. Floors in the facility were clean and safe.
All kitchen, food preparation and storage areas were clean and free of litter/rubbish. 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. The facility had one or more functioning carbon monoxide detectors that meet statutory requirements. Continued on LIC809-C
SUPERVISOR'S NAME: Luisa GavoutianTELEPHONE: (559) 650-7879
LICENSING EVALUATOR NAME: Theresa MarquezTELEPHONE: (559) 341-7123
LICENSING EVALUATOR SIGNATURE:
DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2023
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: A GOOD TIME OUT
FACILITY NUMBER: 153808447
VISIT DATE: 06/01/2023
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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.
LPA also reviewed a sample of 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. Staff records contained documentation of meeting qualification requirements. At least one person trained in CPR and pediatric First Aid is present when children are at the facility or at off-site activities.

Director Amy Bennett 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.
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

LPA and Bennett discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Assembly Bill 2370, Chapter 676, Statutes of 2018 requires all Child Care Centers (CCCs) that are located in buildings constructed before January 1, 2010 to test their drinking water for lead contamination by January 1, 2023 and every 5 years thereafter. This facility has provided evidence of completed water testing for samples collected on 3/25/2023 with no action level exceedances noted.

Per Chapter 1, Division 12, Title 22 of the California Code of Regulations, the following deficiencies were found; Medical Assessements were missing from "drop in" day care children facility files. (see page LIC809-D):

An exit interview was conducted with Amy Bennett. LPA provided Bennett with a copy of the Facility Evaluation Report (LIC 809), Appeal Rights, and the Notice of Site Visit form (LIC 9213). The LIC 9213 is required to be posted for 30 days.
SUPERVISOR'S NAME: Luisa GavoutianTELEPHONE: (559) 650-7879
LICENSING EVALUATOR NAME: Theresa MarquezTELEPHONE: (559) 341-7123
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 06/01/2023 02:22 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: A GOOD TIME OUT
FACILITY NUMBER: 153808447

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/01/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101221(b)(8)
CHILD RECORDS
(b) Each record shall contain information including, but not limited to, the following: (8) Medical assessment, including ambulatory status as specified in Section 101220, and the following health information:

This requirement is not met as evidenced by:
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. The facility does not obtain medical assessments for "drop in" day care children. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/01/2023
Plan of Correction
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Director agreed to begin requesting Medical Assessments for ALL enrolled day care children.
Director will submit a written statement she has obtain medical assessments for currently enrolled day care children by July 1, 2023.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Luisa GavoutianTELEPHONE: (559) 650-7879
LICENSING EVALUATOR NAME: Theresa MarquezTELEPHONE: (559) 341-7123
LICENSING EVALUATOR SIGNATURE:
DATE: 06/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2023
LIC809 (FAS) - (06/04)
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