<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 160407116
Report Date: 03/04/2020
Date Signed: 03/05/2020 12:09:46 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:KINGS RIVER-HARDWICK PRESCHOOLFACILITY NUMBER:
160407116
ADMINISTRATOR:GOLDRING, LESLIEFACILITY TYPE:
850
ADDRESS:10300 EXCELSIOR AVENUETELEPHONE:
(559) 584-4475
CITY:HANFORDSTATE: CAZIP CODE:
93230
CAPACITY:24CENSUS: 20DATE:
03/04/2020
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Mani FrauenheimTIME COMPLETED:
10:50 AM
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
On 3/42020, Licensing Program Analyst (LPA) Kathy Pacheco conducted an unannounced plan of correction inspection at the facility. LPA met with Lead Teacher, Mani Frauenheim, to verify plan of correction for deficiency of Personnel Requirements that was cited on 2/3/2020.

LPA reviewed Lead Teacher's staff file that did not contain mandatory documentation to ensure the deficiency was corrected. LPA discovered the staff file was still missing proof of the required staff immunization (Pertussis/Measles/Influenza) and/or written declaration declining flu shot.

Per California Code of Regulations, Title 22, Division 12, the following deficiency was cited: (see next page for deficiency)

Exit interview conducted with Lead Teacher. Lead Teacher was provided a copy of the Facility Evaluation Report, Appeal Rights, and the (LIC 9213) Notice of Site Visit Form. The Facility Evaluation Report is required to remain in the facility for public review. The LIC 9213 form is required to be posted for 30 days.
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Kathy PachecoTELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2020
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 2
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: KINGS RIVER-HARDWICK PRESCHOOL
FACILITY NUMBER: 160407116
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/13/2020
Section Cited

1
2
3
4
5
6
7
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 influenza vaccination between August 1 and December 1 of each year.
8
9
10
11
12
13
14
This requirement was not met as evidenced by staff file review conducted by LPA. The staff file for lead teacher did not contain proof of the required immunizations. This poses a potential risk to the health, safety, or personal rights of children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7

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: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Kathy PachecoTELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:
DATE: 03/04/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/04/2020
LIC809 (FAS) - (06/04)
Page: 2 of 2