203801227-11-19-2021-04-CC-CBRN-C8WUUJ-20211119145338

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 203801227
Report Date: 11/19/2021
Date Signed: 11/19/2021 02:53:46 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 START		FACILITY NUMBER:	203801227
ADMINISTRATOR:	LOPEZ, ELIZABETH		FACILITY TYPE:	830
ADDRESS:	917 E. OLIVE AVENUE		TELEPHONE:	(559) 675-9137
CITY:	MADERA	STATE: CA	ZIP CODE:	93638
CAPACITY:	24	CENSUS:	DATE:	11/19/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	07:30 AM
MET WITH:	Lina Bojorquez		TIME COMPLETED:	03:15 PM

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On November 19, 2021 Licensing Program Analyst (LPA) Brannon, conducted an unannounced Annual Required Inspection for the infant license. LPA met with Center Director, Lina Bojorquez, and toured the facility indoors and outdoors. Days and hours of operation are Monday through Friday, 8:00 AM to 4:00 PM.

There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. No poisons were observed during the inspection.

Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Playground equipment is in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. Hand washing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe. Meals are provided by the main kitchen. All food is protected against contamination and any contaminated food is discarded immediately. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors. The infant program utilizes igloos with cup dispenser and disposable cups. Areas around climbing equipment, swings and slides have cushioning material to absorb falls. The infant program utilizes wood chip and rubber pour as cushioning in two different areas. The older yellow/red/blue climbing structure has some plastic screw covers falling off. Duct tape has been placed over the exposed screws.The facility is free of flies, insects and rodents. There is a working carbon monoxide detector. Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have received a criminal record clearance or exemption. Upon notification from the Department, the licensee will comply and act immediately to terminate the employment of, remove from the facility or bar from entering the facility for any person it is deemed necessary while the Department considers granting or denying an exemption. Capacity and limitations as specified on the license are being maintained.

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SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia Brannon	TELEPHONE: (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: 203801227
	VISIT DATE: 11/19/2021

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At least one person trained in CPR and Pediatric First Aid is present when children are at the facility. Sierra Vista Migrant Head Start director or fully qualified teacher designated to act in the director’s absence has been reported to the Department. The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. All infants are under supervision, including visual supervision, of a teacher at all times. There is a ratio of one teacher supervising no more than four infants in care. LPA reviewed a sample of infants’ files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child, medical assessment, individual feeding plan, and Infant Needs and Services Plan. LPA reviewed a sample of staff files and observed files were complete with health screening, immunization records for influenza, pertussis and measles and current documentation of completed mandated reporter training. Staff records contain documentation of meeting qualification requirements. Menus are posted at least one week in advance where an authorized representative can view them. The facility has sufficient age appropriate furniture, and equipment including cribs, cots or mats, changing tables and feeding chairs. During today’s inspection, Center Director provided a copy of an invoice for the one inch changing table pad.

There is indoor and outdoor activity space for infants that is physically separate. During today’s inspection, LPA observed that the infant play yard does not coincide with the outdoor facility sketch that was provided by licensee. The new infant play yard has been installed on part of the preschool outside play area. Upon further questioning, LPA was informed that licensee, Community Action Partnership of Madera recently install a new infant play yard without notifying Community Care Licensing as required per Title 22, Section 101212(c) Reporting Requirements. LPA requested the following information to assist in facilitating the process of licensing the new infant play yard:

1) Updated Center application, LIC 200A

2) A Board Resolution authorizing the new infant play yard and name the contact person 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).

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SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia Brannon	TELEPHONE: (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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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: 203801227
	VISIT DATE: 11/19/2021

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4) Updated personnel report, LIC 500

5) Updated Emergency Disaster Plan, LIC 610

6) Manufacturing specifications of the new infant climbing equipment.

LPA reviewed with staff that infants are not allowed to play in the new infant play yard until the required documentation is sent to Fresno Community Care Regional office, installed permanent shade structure is completed and an inspection from Licensing.

Each crib, mat or cot is occupied by only one infant at time and cribs are kept free from all loose articles including blankets and pillows and there are no objects hanging above or attached to the crib. Infants are not swaddled while in care. Staff physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Documentation for infants up to 12 months includes sleeping position if it is other than on their back. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping. Staff-infant ratio requirements are being met while infants are sleeping.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiency is cited: (see next page, 809 D). Licensee was provided a copy of their appeal rights.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia Brannon	TELEPHONE: (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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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: 203801227
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/19/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101212(c)

The licensee shall notify the Department in writing of his/her intent prior to making any structural changes that reduce the total amount of indoor or outdoor activity space. This requirement is not met as evidenced by: licensee installed a new infant outdoor play yard in the area desiganted for the preschool children's outside play area. Licensee did not provide updated required documentation nor was an inspection conducted by Licensing, approving the new area.
	Deficient Practice Statement
1 2 3 4	Based on LPA's observation and interviews with Center Director, the licensee did not comply with the section cited above in which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/20/2021
	Plan of Correction
1 2 3 4	Licensee shall provide the required documents as listed in the report. Documentation and an inspection from Licensing for clearance are required before the infants are allowed to play in the new infant play yard. At this time, staff will not allow infants to play in the new infant yard until clearance is granted. Licensee shall turn in the required documentation no later than December 20, 2021.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia Brannon	TELEPHONE: (559) 388-3635
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021

LIC809 (FAS) - (06/04)

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