153808928-12-20-2019-04-CC-JTHN-BK2P6N-20191220100235

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 153808928
Report Date: 12/17/2019
Date Signed: 12/20/2019 10:02:50 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:	SPECIAL EXPLORERS CENTER		FACILITY NUMBER:	153808928
ADMINISTRATOR:	BOWDEN, DAMIAN		FACILITY TYPE:	840
ADDRESS:	401 19TH STREET		TELEPHONE:	(661) 703-9176
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93301
CAPACITY:	30	CENSUS: 19	DATE:	12/17/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Damian Bowden- Director		TIME COMPLETED:	05:15 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	Licensing Program Analyst (LPA) Jessika Thompson conducted an unannounced annual/random inspection. LPA met with Director Damian Bowden. A tour of the facility, as shown on the facility sketch was performed. This program operates year-round, Monday through Friday from 12:00 PM to 6:30 PM. Snack and dinner is provided. There are no bodies of water. Firearms and ammunition are not on the premises. Furniture, equipment and materials are sufficient, age appropriate, in good repair and toxic free. Rooms and floors are safe and clean. The licensee is taking measures to keep the facility free of insects, rodents, etc. Staff subject to a criminal record clearance or exemption is associated to the facility. Conditions, limitations and capacity specified on license are in compliance. First Aid/CPR reviewed and in compliance. Facility has at least one functioning carbon monoxide detector that meets statutory requirements. Teacher/child ratios are maintained, and adequate supervision is provided during visit. Menus are posted. A sample of children's and staff’s records reviewed. Children’s records include required information including; Name, address and telephone number of child’s authorized representative and relatives and/or others who can assume responsibility in the event authorized representative cannot be reached. Staff records contain required documentation of the educational background, training, proof of immunization, and Child Abuse Mandated Reporter certification. Lead safety was discussed, and LPA provided Director Bowden with a brochure. Licensee understands that lead safety information must also be provided to parents and/or authorized representatives of children in care. Provider Information Notices were discussed, and Operations Manager Joe Correa is subscribed to receive updates via email. Director Bowden is aware that forms and updated information may be obtained on Community Care Licensing’s website, (www.ccld.ca.gov). Fire and disaster drills are conducted at least once every six months and documented with the date and time. Earthquake safety was discussed and form LIC-9148, Earthquake Preparedness Checklist, is posted on parent’s board. Incidental Medical Services (IMS) policy was discussed. Currently, there are no children enrolled requiring IMS. (see next page)

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika Thompson	TELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019

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: SPECIAL EXPLORERS CENTER	FACILITY NUMBER: 153808928
	VISIT DATE: 12/17/2019

NARRATIVE

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Director Bowden was advised that if/when any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department.

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 deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika Thompson	TELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019

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: SPECIAL EXPLORERS CENTER	FACILITY NUMBER: 153808928
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/17/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/03/2020 Section Cited	1 2 3 4 5 6 7	All personnel, including the licensee, administrator and volunteers, shall be in good health and shall be physically and mentally capable of performing assigned tasks. Except as specified in below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure. This requirement was not met as evidenced by record's review. During today's visit, LPA found that Staff #1's file contained an incomplete TB test.
	8 9 10 11 12 13 14	This poses a potential risk to the health, safety or personal rights of children in care.	8 9 10 11 12 13 14
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	1 2 3 4 5 6 7

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 deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika Thompson	TELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019

LIC809 (FAS) - (06/04)

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