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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 240402889
Report Date: 12/12/2019
Date Signed: 12/13/2019 08:48:26 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:OUR LADY OF MIRACLES PRESCHOOLFACILITY NUMBER:
240402889
ADMINISTRATOR:DORES, JOLEENFACILITY TYPE:
850
ADDRESS:370 LINDEN AVENUETELEPHONE:
(209) 854-3180
CITY:GUSTINESTATE: CAZIP CODE:
95322
CAPACITY:48CENSUS: 14DATE:
12/12/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Joleen DoresTIME COMPLETED:
04:15 PM
NARRATIVE
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An unannounced random visit #2 is made today by LPA Claudia Henley. Met with Joleen Dores, Site Supervisor.There were 14 children present with three staff. A tour of facility was conducted inside and outside. Staff and children were spoken to during visit. The following areas are in compliance during visit: There are no bodies of water. Storage area for poisons is locked. Disinfectants, hazardous items and medications are inaccessible to children. Carbon monoxide is in working condition. Furniture and equipment are sufficient, age appropriate and in good repair. Fire drills are conducted every month and last drill was November 2019. The playground equipment and outdoor activity space is maintained and in good condition. There is adequate amount of pea gravel which is being used as cushioning around the climbing equipment. Children's toilets, hand washing facilities are sanitary. Rooms are safe and clean. Food preparation area is clean, food is protected from contamination, storage containers for solid waste are covered and all food or beverages are stored in covered containers at 45 degrees or less. Drinking water is available both indoors and outside. Menus are posted. The facility is in compliance with conditions and limitations specified on the license. Teacher/child ratios are maintained and adequate supervision is being provided during this visit. Sign in/sign out sheets maintained. First Aid/CPR reviewed and in compliance. Staff and children's records were reviewed. One staff person was present today and criminal record fingerprints were not transferred to this licensed facility. Two staff were missing medical assessments and some staff had not completed the Online Child Abuse Mandated Reporter training.
The child care center hours and days of operation are as follows: Monday through Friday, 7:30 a.m. to 4:00 p.m.

The following is cited per Title 22 Regulations (see page 2). Appeal Rights left with center representative Ms. Dores. Site Visit Notice posted on the parent board. Exit interview conducted.
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Claudia HenleyTELEPHONE: (559) 341-5776
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2019
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 3
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: OUR LADY OF MIRACLES PRESCHOOL
FACILITY NUMBER: 240402889
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/12/2019
Section Cited

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Criminal Record Clearance: All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to
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working, residing or volunteering in a licensed facility: Request a transfer of a criminal record clearance as specified in Section 101170(f). During the inspection, LPA observed Staff #1 present supervising children. Staff #1 was fingerprinted cleared, but licensee failed to transfer Staff #1 fingerprint clearance to this facility. Staff #1 has been working at facility since August of 2019. Therefore a $100.00 civil penalty is assessed during the visit today.

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Type B
01/13/2020
Section Cited

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PERSONNEL REQUIREMENTS: Each person shall have a health-screening report signed by the person performing the screening. This report is

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needed to show staff can perform the duties to be assigned. Upon staff file review, Staff #1 & Staff #4 were missing medical assessments.

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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: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Claudia HenleyTELEPHONE: (559) 341-5776
LICENSING EVALUATOR SIGNATURE:
DATE: 12/12/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/12/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3
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: OUR LADY OF MIRACLES PRESCHOOL
FACILITY NUMBER: 240402889
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/13/2020
Section Cited

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Health & Safety Code - Section 1596.8662: Requires all employees to complete training as specified on their mandated reporter duties.
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Upon staff file review, Staff #1 failed to complete the online training and Staff #4 had completed the wrong online training course (School Personnel).
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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: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Claudia HenleyTELEPHONE: (559) 341-5776
LICENSING EVALUATOR SIGNATURE:
DATE: 12/12/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/12/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3