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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153810004
Report Date: 05/22/2019
Date Signed: 05/22/2019 03:23:16 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:BUTTONWILLOW UNION SCHOOL DISTRICTFACILITY NUMBER:
153810004
ADMINISTRATOR:PACKARD, J. STUARTFACILITY TYPE:
850
ADDRESS:42600 HWY 58TELEPHONE:
(661) 764-5166
CITY:BUTTONWILLOWSTATE: CAZIP CODE:
93206
CAPACITY:24CENSUS: 18DATE:
05/22/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Stuart Packard - Director TIME COMPLETED:
03:35 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jessika Thompson conducted an unannounced annual/random inspection. LPA met with Director Stuart Packard. 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. Furniture, equipment and materials are sufficient, age appropriate, in good repair and toxic free. This program operates within the traditional school year schedule, daily, from 8:15 AM to 12:10 PM. Breakfast, lunch and snack is provided and prepared in the school cafeteria, where children also eat. 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. Contaminated food is discarded immediately, when applicable. Storage containers for solid waste are in good repair. Sanitary drinking water is available both indoors and outdoors. 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. Sign In/Sign Out sheets contain parent's full legal signature and time of day. Menus are posted. A sample of children's and staff’s records were reviewed. Children’s records include consent for emergency medical treatment. Lead safety information was provided to Teacher Karen Ehinger. Licensee understands that a lead safety brochure must be disseminated to parents, and/or authorized representatives of children in care. To order forms, etc. visit our website at www.ccld.ca.gov.

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

DATE: 05/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
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 4
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: BUTTONWILLOW UNION SCHOOL DISTRICT
FACILITY NUMBER: 153810004
VISIT DATE: 05/22/2019
NARRATIVE
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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: 05/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: BUTTONWILLOW UNION SCHOOL DISTRICT
FACILITY NUMBER: 153810004
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/05/2019
Section Cited
CCR
101238(a)(1)
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101238(a)(1) Buildings and Grounds. The child care center shall be clean, safe, sanitary and in good repair at all times. In addition, the licensee shall take measures to keep the center free of flies, other insects and rodents. This requirement was
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Director Packard removed glue trap during today's inspection. Director Packard stated that the outside of the center is sprayed on a bi-monthly basis by professional pest control company.
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not met, as evidenced by inspection conducted by LPA. On this date, LPA observed an insect glue trap on the floor, under a desk within the teacher's office, which is inside of the center's sole classroom. The glue trap contained two dead insects. Although the teacher's office is not an area utilized by children in care, the door does not contain a locking mechanism restricting access. This poses a potential risk to the health and safety of children in care.
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Licensee to provide LPA with a written plan of correction detailing all methods currently used for insect abatement. This should include a schedule of when the facility will be sprayed. Licensee to also detail the safety precautionary measures put in place to protect children from accessing insect abatement products. This plan of correction is to be submitted to the Fresno Community Care Licensing Office by 06/05/19.
Type B
08/10/2019
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 volunteer shall receive an
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Licensee will send proof of the required immunizations, for all staff that has direct contact with children in care, to the Fresno Community Care Licensing office by 08/10/19.
(This facility will be closing for the summer commencing, 05/31/19)
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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 records for Staff #1, Staff #2, and Staff #3. 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: 05/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: BUTTONWILLOW UNION SCHOOL DISTRICT
FACILITY NUMBER: 153810004
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/05/2019
Section Cited
CCR
1596.841
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Current roster of children provided care in facility required. Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon request.


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Licensee to send a copy of a completed LIC 9040, Children's Roster, to the Fresno CCL office by 06/05/19.
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This requirement was not met, as evidenced by records review conducted. Today, facility staff was unable to provide LPA with a completed LIC 9040, Children's Roster. This poses a potential risk to the health and safety of children in care.
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Type B
08/10/2019
Section Cited
CCR
101217(a)(11)
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Personnel Records. Personnel records shall be maintained on the licensee, administrator, and each employee, and shall contain specified information. (11)A health screening as specified in Section 101216(g). This requirement was not met, as evidenced by records review. Today, the licensee was
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Licensee to submit health screening information, for aforementioned employees, to the Fresno CCL office by 08/10/19. (This facility will be closing for the summer commencing, 05/31/19)
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unable to provide health screening information for Staff #1, Staff #2 and Staff #3. This poses a potential risk to the health and safety of 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: 05/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4