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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203801180
Report Date: 11/19/2021
Date Signed: 11/19/2021 02:29:48 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:SIERRA VISTA MIGRANT HEAD STARTFACILITY NUMBER:
203801180
ADMINISTRATOR:SANDOVAL, SYLVIAFACILITY TYPE:
850
ADDRESS:917 E. OLIVE AVENUETELEPHONE:
(559) 675-9137
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY:88CENSUS: DATE:
11/19/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
07:45 AM
MET WITH:Lina BojorquezTIME COMPLETED:
03:15 PM
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 Licensing Program Analyst (LPA) Brannon met with Center Director, Lina Bojorquez and Patricia Almanza, Health Specialist.
During today's inspection, LPA observed that the preschool outdoor facility sketch did not coincide with the facility sketch provided by licensee, Community Action Partnership of Madera County. LPA observed that the preschool play yard square footage had diminished due to licensee installing a new infant play yard on the outside area designated for the preschool children. The outside square footage assists in determining the facility preschool capacity.
LPA requested the following information to assist in facilitating the process of finalizing the preschool capacity.

1) Updated Center application, LIC 200A

2) A Board Resolution authorizing the new infant play yard and name the contact person who is authorized to work on behalf of the Board with Licensing.

3) Updated facility sketch.

a. This is to include the required permanent shade structure as required by Title 22, 101238.2(b)(1) and 101438.2 (a).

4) Updated personnel report, LIC 500

5) Updated Emergency Disaster Plan, LIC 610

6) Manufacturing specifications of the new infant climbing equipment.

CONTINUED ON FOLLOWING PAGE

SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 388-3635
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021
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: SIERRA VISTA MIGRANT HEAD START
FACILITY NUMBER: 203801180
VISIT DATE: 11/19/2021
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 An inspection by Licensing will be required to measure the new area of the preschool play yard to verify if capacity has been decreased due to the changes. Licensee will send in the required documentation and an inspection will be conducted. During today's visit, LPA reviewed facility sketch with Center Director and Health Specialist.

Per California Code of Regulations Title 22, Division 12, no deficiency to be cited. Exit interview conducted with Center Director, Lina Bojorquez. A Notice of Site Visit was posted on parent board.

A COPY OF THIS REPORT IS TO REMAIN IN THE FACILITY FOR PUBLIC REVIEW.
THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 388-3635
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021
LIC809 (FAS) - (06/04)
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