<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243808259
Report Date: 02/06/2023
Date Signed: 02/06/2023 01:57:02 PM


Document Has Been Signed on 02/06/2023 01:57 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:SOUTH DOS PALOS HEAD STARTFACILITY NUMBER:
243808259
ADMINISTRATOR:TOVAR, ARACELIFACILITY TYPE:
850
ADDRESS:8540 CHRISTIANTELEPHONE:
(209) 827-5641
CITY:DOS PALOSSTATE: CAZIP CODE:
93665
CAPACITY:42CENSUS: 28DATE:
02/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Araceli TovarTIME COMPLETED:
02:15 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 02/06/23 Licensing Program Analyst (LPA) Araceli Gibson conducted an unannounced annual inspection. LPA met with Site Supervisor/Master Teacher Araceli Tovar. The program runs a regular school year program Monday through Friday from 8:00 AM to 2:30 PM with a census of 28 children today. Meals are provided by the West Side Kitchen breakfast, lunch, and afternoon snack are prepped and served in the classroom.

LPA toured the facility, both indoors and outdoors to inspect areas accessible to children in care. 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. All toilets and handwashing facilities are in safe and sanitary. Floors in the facility are clean and safe. All kitchen, food preparation and storage areas are clean, free of litter/rubbish and free of rodents/vermin. All food is protected against contamination and any contaminated food is discarded immediately. LPA advised solid waste storage containers have tight-fitting covers and should be in good repair.

Assembly Bill 2370, Chapter 676, Statutes of 2018 requires all Child Care Centers (CCCs) that are located in buildings constructed before January 1, 2010 to test their drinking water for lead contamination by January 1, 2023 and every 5 years thereafter. This facility is unable to provide evidence of completed water testing or evidence of a granted waiver. (See 809D for plan of correction). As of 2014 the facility has been providing Alhambra bottled water for the daycare children both indoors and outdoors. Facility will continue to do so, until either a waiver is granted or testing is completed. Continue 809C

SUPERVISOR'S NAME: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Araceli GibsonTELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:
DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2023
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


Document Has Been Signed on 02/06/2023 01:57 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: SOUTH DOS PALOS HEAD START
FACILITY NUMBER: 243808259

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above Licensee has not tested the water at the facility, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/06/2023
Plan of Correction
1
2
3
4
Licensee agrees to either have the water tested as required by Assembly Bill 2370 or submit a request for a waiver to be considered for exemption to Community Care Licensing Department by POC date 03/06/23. If testing the water in the facility, the written directives require that the facility submit to your LPA copies of the following documents within 2 weeks of the completed sampling date:
   (1) Completed and signed External Water Sampler Self-Certification Form (LIC 9275).
   (2) Facility Sketch (LIC 999) fully labeled with the locations of all water outlets, including outlets that will not be sampled.
   (3) Completed and signed Child Care Center Sampling Checklist Form (LIC 9276).
Type B
Section Cited
CCR
101161(a)
Limitations on Capacity and Ambulatory Status
(a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interviews with teachers room 1 has the Home Base program utilizing half of the room for an hour and a half for up to 12 children which include, pregnant parents, infants and toddlers ages 0-36 months twice a month. This space is licensed for preschool and as a toddler option for 4 toddler children ages 18-36 months, therefore operating outside limitations of the capacity of the license, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/06/2023
Plan of Correction
1
2
3
4
Licensee agrees to apply for a decrease in capacity to eliminate the toddler option or apply for a waiver that specifically meets the needs for infants and toddlers ages 0-36 months to maintain compliance of the license issued by CCLD.
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: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Araceli GibsonTELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:
DATE: 02/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: SOUTH DOS PALOS HEAD START
FACILITY NUMBER: 243808259
VISIT DATE: 02/06/2023
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
26
27
28
29
30
31
32
LPA advised areas around high climbing equipment, swings and slides may need more cushioning material to absorb falls. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. 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 needs revision with CCLD (see 809D for further).

At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at offsite activities. Center director or fully-qualified teacher designated to act in the director’s absence has been reported to the Department. Facility is maintaining signing children in/out of the facility by authorized representatives at the site. All children are under supervision, including visual supervision, of a teacher at all times. Facility maintains a ratio of one teacher supervising no more than 12 children in care when in person learning is conducted. LPA Gibson reviewed a sample of children’s files and were observed to be complete. Emergency cards with contact information for authorized representative and or relatives or others who can assume responsibility for the child and medical assessment. LPA Gibson 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. Menus are posted at least one week in advance where an authorized representative can view them.

Incidental Medical Services (IMS) are 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 1, of the California Code of Regulations, the following deficiencies are being 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: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Araceli GibsonTELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3