163801067-11-15-2019-04-CC-KPAO-BHXPQF-20191115103105

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 163801067
Report Date: 11/13/2019
Date Signed: 11/15/2019 10:31:09 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:	PRESTON J. GREEN, SR., LEARNING CENTER		FACILITY NUMBER:	163801067
ADMINISTRATOR:	BURSIAGA, CHRISTINA		FACILITY TYPE:	850
ADDRESS:	11411 SOUTH ELEVENTH AVENUE		TELEPHONE:	(559) 582-5184
CITY:	HANFORD	STATE: CA	ZIP CODE:	93230
CAPACITY:	170	CENSUS: 138	DATE:	11/13/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Christina Burisaga		TIME COMPLETED:	11:45 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 this date, Licensing Program Analyst (LPA) Kathy Pacheco conducted an unannounced annual/random inspection. LPA met with Administrator, Christina Bursiaga. A tour of the facility was conducted, inside and outside, as shown on the facility sketch. There are no bodies of water, firearms and/or ammunition on the premises. Disinfectants, hazardous items and medications are inaccessible to children. Storage area for poisons is locked and 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. 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 have a full legal signature and time of day. Teacher/child ratios are maintained and adequate supervision is provided during inspection. Menus are posted. A sample of children's and staff’s records reviewed. Children’s records include required medical and consent for emergency medical. Staff records contain required documented health screening. Licensee provided proof of required immunization (Pertussis/Measles/Influenza) and/or written declaration declining flu shot, as well as, proof of completion of required Mandated Reporter Training. (continued on next page)

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Kathy Pacheco	TELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2019

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: PRESTON J. GREEN, SR., LEARNING CENTER	FACILITY NUMBER: 163801067
	VISIT DATE: 11/13/2019

NARRATIVE

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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. Child #1 (see Confidential Names Form (LIC 811) dated November 13, 2019) requires an Epinephrine Auto-Injector, however, currently does not have one on site. Staff informed LPA they returned the Epinephrine Auto-Injector to child #1's parent because it was expired. Staff further stated parent told them they will bring in an Epinephrine Auto-Injector that is not expired.

Operating hours are Monday through Friday 7:30 AM to 5:30 PM

NO DEFICIENCIES OBSERVED IN THE AREAS INSPECTED TODAY.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.

A copy of this report must remain in the facility for public review.

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Kathy Pacheco	TELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2019

LIC809 (FAS) - (06/04)

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