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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 163808336
Report Date: 11/20/2019
Date Signed: 11/21/2019 02:28:30 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:KCAO LEE RICHMOND PRESCHOOLFACILITY NUMBER:
163808336
ADMINISTRATOR:WASHINGTON, LACRETIAFACILITY TYPE:
850
ADDRESS:939 KATIE HAMMOND LANETELEPHONE:
(559) 585-3760
CITY:HANFORDSTATE: CAZIP CODE:
93230
CAPACITY:22CENSUS: 20DATE:
11/20/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Ysidra JungTIME COMPLETED:
02:15 PM
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On this date, Licensing Program Analyst (LPA) Kathy Pacheco conducted an unannounced annual/random inspection and met with Lead Teacher, Ysidra Jung. A tour of the facility was conducte, inside and outside, as shown on the facility sketch. There were no bodies of water, firearms and/or ammunition on the premises. Disinfectants, hazardous items and medications were inaccessible to children. Storage area for poisons were locked and inaccessible to children. Furniture, equipment and materials were sufficient, age appropriate, in good repair and toxic free. The playground equipment and outdoor activity space was maintained and in good condition, free of hazards with adequate cushioning material. Children's toilets and hand washing facilities were sanitary and in good operating condition. Rooms and floors were safe and clean. The meals for the facility are prepared off-site at the Kings County Action Organization (KCAO) main kitchen and are transported to and from the facility. Contaminated food was discarded immediately, when applicable. Storage containers for solid waste were in good repair with tight-fitting covers. Sanitary drinking water was available both indoors and outdoors. The Licensee was taking measures to keep the facility free of insects, rodents, etc. No excluded adults were present at the facility. Conditions, limitations and capacity specified on license were in compliance. Staff requiring criminal record clearance or exemptions are associated to the facility as indicated on LIS 555 – 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 had a full legal signature and time of day. Teacher/child ratios were maintained and adequate supervision was provided during inspection. Menus were posted. A sample of children's and staff’s records were reviewed. Children’s records included required medical and consent for emergency medical treatment. Staff records contained 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 completed required Mandated Reporter Training for all staff.

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SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Kathy PachecoTELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2019
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: KCAO LEE RICHMOND PRESCHOOL
FACILITY NUMBER: 163808336
VISIT DATE: 11/20/2019
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This facility operates Monday through Friday with two sessions: 8:00 AM to 11:30 AM and 1:00 PM to 4:30 PM. The center operates on the traditional school year calendar.

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.

NO DEFICIENCIES OBSERVED IN THE AREAS INSPECTED TODAY.

LIC 9213 NOTICE OF SITE VISIT FORM WAS PROVIDED TO FACILITY AND 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: 11/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2019
LIC809 (FAS) - (06/04)
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