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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 163801067
Report Date: 10/02/2019
Date Signed: 10/02/2019 02:36:45 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:PRESTON J. GREEN, SR., LEARNING CENTERFACILITY NUMBER:
163801067
ADMINISTRATOR:BURSIAGA, CHRISTINAFACILITY TYPE:
850
ADDRESS:11411 SOUTH ELEVENTH AVENUETELEPHONE:
(559) 582-5184
CITY:HANFORDSTATE: CAZIP CODE:
93230
CAPACITY:170CENSUS: 149DATE:
10/02/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Christina BursiagaTIME COMPLETED:
11:15 AM
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On this date, Licensing Program Analyst (LPA) Kathy Pacheco conducted an unannounced case management inspection at the facility. LPA met with Administrator, Christina Bursiaga, to verify a plan of correction for deficiency that was cited on 1/8/19.

LPA toured the facility inside and outside and took a census. LPA observed the playground area, utilized by classrooms 4, 5, and 6, and verified the facility has artificial turf surrounding the play equipment. LPA was also provided with documentation from the facility, including: a certificate of padding from the artificial turf manufacturer, Polygreen Foam, and a Test Report from Testing Services, Inc., evaluating the artificial turf for Shock Absorbing Properties in Accordance with the procedures outlined in ASTM F 1292-04, Standard Specification for Impact Attenuation of Surface Systems Under and Around Playground Equipment. LPA observed the playground area that was previously cited on 1/8/19 and verified the facility has artificial turf with adequate cushioning that surrounds the playground equipment, to include the fall zones of the playground equipment.

Based on observations of documents and areas of the facility, LPA determined the facility corrected the deficiency.

Per California Code of Regulations Title 22, Division 12, no deficiency cited during today's inspection.

LIC 9213 NOTICE OF SITE VISIT 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: 10/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019
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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