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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 163808035
Report Date: 09/27/2019
Date Signed: 09/27/2019 02:36:27 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:KETTLEMAN CITY HEAD START / KCAO, INC.FACILITY NUMBER:
163808035
ADMINISTRATOR:TAFOLLA, ARACELIFACILITY TYPE:
850
ADDRESS:75 FIFTH STTELEPHONE:
(559) 386-9879
CITY:KETTLEMAN CITYSTATE: CAZIP CODE:
93239
CAPACITY:24CENSUS: 23DATE:
09/27/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Vanessa MendozaTIME COMPLETED:
02:45 PM
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An unannounced Annual inspection was conducted today by Licensing Program Analyst (LPA) Robert Gutierrez. LPA met with Site Supervisor Vanessa Mendoza and toured the facility, both indoors and outdoors. There are no swimming pools or other bodies of water on the premises. Firearms and ammunition are not permitted on the premises. All children are under supervision, including visual supervision, of a teacher at all times. There is a ratio of one teacher supervising no more than 12 children in attendance. Disinfectants, cleaning solutions and other dangerous items shall be inaccessible to children. No poisons were observed during today’s inspection. All materials and surfaces accessible to children are toxic free. All toilets, hand washing, and bathing facilities are in safe and sanitary operating conditions. All floors are clean and safe. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. All kitchen, food prep, and storage areas are clean, free of litter, rubbish, and rodents/vermin. All food is protected from contamination, and contaminated food is discarded immediately. LPA observed one trash can without a tight fitting lid. Inside this trash can LPA observed food and other solid waste. The other four trash cans had a tight fitting lid. Uncontaminated drinking water is available both indoors and outdoors. All foods/beverages capable of rapid spoiling are stored in covered containers at 45 (F) or less. Playground equipment is in good condition, free of sharp, loose, or pointed parts. Outdoor activity space surface is maintained in a safe condition and is free of hazards. Areas around high climbing equipment, swings, and slides have cushioning material to absorb falls. Community Care Licensing (CCL) shall notify a licensee to immediately terminate the employment of, or to remove/bar any person with specified convictions or for other reasons. The licensee shall comply with the notice. Before working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have a clearance or exemption and have been associated to the facility. Staff records contain appropriate, documentation of education credits. A file review conducted prior to today’s inspection determined that the CCL office has yet to receive any paperwork to list Ms. Mendoza as the site supervisor. Licensee has until 10/27/2019 to submit a change of director packet to CCL.

Continued on 809-C
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Robert GutierrezTELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2019
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 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: KETTLEMAN CITY HEAD START / KCAO, INC.
FACILITY NUMBER: 163808035
VISIT DATE: 09/27/2019
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At least one person trained in CPR and Pediatric first-aid is present when children are at the facility or at off-site activities. Child's admission agreement is available for review. Required CCL forms such as facility license, personal rights, menus, child passenger restraint system poster, daily activity schedule, emergency disaster plan, earthquake preparedness checklist, and parent’s right poster are posted on the parent board. This is a full day program which operates on a traditional school year schedule. The hours of operation are 8:00am to 2:30pm, Monday through Friday.

Incidental Medical Services (IMS) are not currently being provided. The following information regarding Americans with Disability Act (ADA) was provided: US Department of Justice toll free ADA Information line at (800) 514-0301(voice) and (800) 514-0383 (TDD) and website link
https://www.ada.gov/childqanda.htm for Commonly Asked Questions about Child Care Centers and the ADA.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINS), Quarterly Updates, Mandated Reporter Training, Lead Poisoning Facts, Forms and Regulations.

Per Chapter 1, Division 12, Title 22 of the California Code of Regulations no deficiencies are observed today. Site Visit Notice posted on the parent board. Exit interview was conducted with Vanessa Mendoza.

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.



LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Robert GutierrezTELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2019
LIC809 (FAS) - (06/04)
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