243808263-12-13-2022-04-CC-AGIN-CM3VNN-20221213153526

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 243808263
Report Date: 12/13/2022
Date Signed: 12/13/2022 03:35:34 PM

Document Has Been Signed on 12/13/2022 03:35 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:	ELIM HEAD START		FACILITY NUMBER:	243808263
ADMINISTRATOR:	HENDRICKSEN, CHRISTIE		FACILITY TYPE:	850
ADDRESS:	7677 LANDER AVENUE		TELEPHONE:	(209) 381-5170
CITY:	HILMAR	STATE: CA	ZIP CODE:	95324
CAPACITY:	20	CENSUS: 7	DATE:	12/13/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Nicole Cabacungan		TIME COMPLETED:	03:45 PM

NARRATIVE

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On 12/13/22 Licensing Program Analyst (LPA) Araceli Gibson, conducted an unannounced annual inspection. LPA met with Master Teacher, Nicole Cabacungan. Preschool has two sessions AM with 7 children present and 7 present in the PM. LPA toured the facility, both indoors and outdoors to inspect areas accessible to children in care. This year the school year started 08/16/22 and ends on 06/06/23 and operates Monday through Friday from 8:00 AM to 11:30 AM and 1:00 PM to 4:30 PM. Breakfast and lunch and snack are provided by Schelby Headstart.

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.

Playground, furniture and equipment are in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and monitored for hazards. All toilets and handwashing facilities are in safe and sanitary operating condition. During today’s inspection LPA was informed water at the facility is unsafe to drink, and water fountains for children were still accessible. The water fountains were covered to make inaccessible and Type B deficiency was cleared on site visit. In addition the facility is currently providing water by purchasing it and Alhambra water company as an alternative source of water. LPA also addressed reporting responsibilities for the water issue by review of facility records the incident was not reported to Community Care Licensing CCL(see 809 D for further.)

Floors in the facility are clean and safe. Breakfast and lunch and snack is served in the classroom. 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 by jug and cups. Areas around high climbing equipment, swings and slides have cushioning material to absorb falls however was advised to rake the wood chips and monitor more frequently. The facility is free of flies, insects and rodents. (Cont. 809C)

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Araceli Gibson	TELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022

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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Document Has Been Signed on 12/13/2022 03:35 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: ELIM HEAD START	FACILITY NUMBER: 243808263
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/13/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101212(D)(1)(C)

(C) Any unusual incident or child absence that threatens the physical or emotinal health or safety of any child. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above LPA reviewed records indicating closure of afternoon session on September 7, 2022 for lack of water, nor was the issues with unsafe drinking water reported to CCLD, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/01/2023
	Plan of Correction
1 2 3 4	Facility to submit a unusual incident report regarding water contamination and associated closure on 9/7/22 PM session. Facility to submit an updated plan of operation for compliance complete with records explaining how they will provide safe drinking water to staff, children and visitors complete with dates of duration. Facility to provide evidence of notification to authorized representatives. All corrections to be made by 1/01/23.

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: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Araceli Gibson	TELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/13/2022 03:35 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: ELIM HEAD START	FACILITY NUMBER: 243808263
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/13/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101238(a)

Buildings and Grounds

(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above In Septemeber of 2022 Master teacher at ELIM Headstart was informed due to construction around Hilmar the water is unsafe to drink. LPA observed two functioning water fountains accessible to children.which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/13/2022
	Plan of Correction
1 2 3 4	Master Teacher made water fountains inacessible by means of a plastic taped bag over each fountain.

Type B

Section Cited

CCR

101215.1(d)

Child Care Center Director Qualifications and Duties

(d) The child care center director, or the substitute director as specified in (f) below, shall be on the premises during the hours the center is in operation. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above desginated substitute director on site has not been reported to the CCLD. Director qualifications are incomplete missing orientation certificate in which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/13/2023
	Plan of Correction
1 2 3 4	Master Teacher agrees to submit director packet for ELIM Headstart by POC date 1/13/23.

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 Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Araceli Gibson	TELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022

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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: ELIM HEAD START	FACILITY NUMBER: 243808263
	VISIT DATE: 12/13/2022

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Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. As a condition of employment for is for all staff to have a fingerprint clearance 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.

At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at offsite activities. The name of the child care center director or fully-qualified teacher designated to act in the director’s absence has been reported to the Department (see 809D for further). Facility maintains signing children in/out of the facility by authorized representatives at the site by means of an IPAD AP Child Plus, and paper when needed. 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 reviewed a sample of children’s files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child and medical assessment. 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. Menus are posted at least one week in advance where an authorized representative can view them.

Incidental Medical Services (IMS) are currently being provided. 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.

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).

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 Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Araceli Gibson	TELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022

LIC809 (FAS) - (06/04)

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