163808305-10-1-2019-04-CC-KPAO-BGJMVU-20191001095717

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 163808305
Report Date: 09/27/2019
Date Signed: 10/01/2019 09:57:20 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:	FIRST BAPTIST CHURCH-PLAYSCHOOL		FACILITY NUMBER:	163808305
ADMINISTRATOR:	SUTHERLAND,TAMI		FACILITY TYPE:	850
ADDRESS:	9125 13 1/2 AVENUE		TELEPHONE:	(559) 584-6644
CITY:	HANFORD	STATE: CA	ZIP CODE:	93230
CAPACITY:	24	CENSUS: 10	DATE:	09/27/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Tami Sutherland		TIME COMPLETED:	12:00 PM

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, Tami Sutherland, who provided a tour of facility, 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 facility 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 as indicated on LIS 531 – 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 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, including proof of required immunization (Pertussis/Measles/Influenza) and/or written declaration declining flu shot, as well as, proof of required Mandated Reporter Training. Incidental Medical Services (IMS) policy was discussed. Licensee is aware that an IMS plan is required to be submitted to the Licensing office if they provide any of these services. (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: 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)

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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: FIRST BAPTIST CHURCH-PLAYSCHOOL	FACILITY NUMBER: 163808305
	VISIT DATE: 09/27/2019

NARRATIVE

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LPA provided Licensee with information regarding the California Department of Social Services (CDSS) Provider Information Notices (PINs) communication system, as well as, information regarding AB 2370, Chapter 676, Statutes of 2018, requiring child care providers to inform parents and/or guardians with lead safety information, and other important resources and information links offered on the CDSS website.

Operating hours are Monday-Friday 8:30 AM – 12:00 PM

No deficiencies observed in the areas inspected today.

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

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Kathy Pacheco	TELEPHONE: (559) 341-5116
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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