243808553-10-7-2019-04-CC-GBAA-BGQSUF-20191007141104

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 243808553
Report Date: 10/07/2019
Date Signed: 10/07/2019 02:11:11 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:	SHAFFER PRESCHOOL		FACILITY NUMBER:	243808553
ADMINISTRATOR:	MCCABE, MICHELE		FACILITY TYPE:	850
ADDRESS:	1434 CALIFORNIA STREET		TELEPHONE:	(209) 357-6145
CITY:	ATWATER	STATE: CA	ZIP CODE:	95301
CAPACITY:	24	CENSUS: 21	DATE:	10/07/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Carie Haley		TIME COMPLETED:	03:00 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	An annual random inspection was conducted by Licensing Program Analysts (LPAs) Ginny Badhesha and Claudia Henley. LPAs met with Lead Teacher Carie Haley and toured the facility. Present today was Carie Haley (lead teacher), two assistants and 21 day care children. The preschool classroom is located in a portable on the Shaffer Elementary School grounds. This facility operates a morning and afternoon class during the traditional school year. Days and hours are Monday through Friday from 8:15AM to 11:15AM and 12:15PM to 3:15PM. No bodies of water present. Firearms/weapons are not allowed or stored on premises. All children present receive direct visual supervision at all times. Facility is operating within the approved licensed capacity at this inspection. All disinfectants, cleaning solutions, toxic, poisonous items, and medications are inaccessible to children. All toilets and hand washing areas are in safe and sanitary condition. All floors are clean and safe. Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Preschool provides breakfast and lunch that are delivered daily by Shaffer Elementary School District and are not prepared on site. All food is protected from contamination, and contaminated food is discarded immediately. Solid waste storage vessels, including moveable bins, have tight fitting covers on, and are in good repair. Uncontaminated drinking water is available both indoors and out. Menus are posted at least one week in advance where an authorized representative can view them. Menus shall be dated and kept on file for 30 days and be available for review upon request. Facility has at least one functioning carbon monoxide detector that meets statutory requirements. Playground equipment is in good condition, free of sharp, loose, or pointed parts. Outdoor activity space surface is maintained in safe condition and free of hazards. Areas in the outdoor play area under/around high climbing equipment and slides have sufficient bark cushioning material to absorb falls. Before working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have a clearance or exemption through Shaffer Elementary School District. There are no excluded individuals present at this center. Licensee is aware that upon notice from the Department, any excluded individual must be immediately removed from the center. Staff records contain appropriate documentation of education credits. (Continued on 809-C)

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Gagandip Badhesha	TELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2019

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: SHAFFER PRESCHOOL	FACILITY NUMBER: 243808553
	VISIT DATE: 10/07/2019

NARRATIVE

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At least one person trained in Pediatric CPR/First Aid with the expiration date of August 10, 2021, whom is present when children are at the facility or at off site activities. The responsible person who signs the child in/out uses their full legal signature and records the time of day. Child's admission agreement is available for review.

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.

Licensee will provide updated copies of LIC 308 (Designation of Facility Responsibility) within 30 days.

Licensee was provided with Lead Poisoning Facts brochure.

Per California Code of Regulations, Title 22, Division 12, Chapter 1, in the areas evaluated no deficiency was cited during today's visit.

Exit interview conducted with Lead Teacher Carie Haley and a copy of this report was provided and discussed.

A Notice of Site Visit Form (LIC 9213) was posted on parent's board and must remain posted for 30 days.

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Gagandip Badhesha	TELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2019

LIC809 (FAS) - (06/04)

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