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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243808779
Report Date: 11/19/2019
Date Signed: 11/19/2019 01:57:04 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:STONE RIDGE CHRISTIAN PRESCHOOLFACILITY NUMBER:
243808779
ADMINISTRATOR:TOLBERT, KIMFACILITY TYPE:
850
ADDRESS:2142 E. YOSEMITE AVENUETELEPHONE:
(209) 383-4727
CITY:MERCEDSTATE: CAZIP CODE:
95340
CAPACITY:45CENSUS: 17DATE:
11/19/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kim Tolbert - DirectorTIME COMPLETED:
02:15 PM
NARRATIVE
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(2) Licensing Program Analyst (LPA), Joseph Pacheco and Licensing Program Manager (LPM), Diana de Leon, conducted an unannounced annual/random inspection today. LPA met with Director, Kim Tolbert, and a tour of the facility was conducted inside and outside. Staff and children were spoken to during visit. The following areas were in compliance during today’s inspection: There are no bodies of water present at this facility. There are no firearms or ammunition allowed on the premises. Disinfectants and medications are inaccessible to children. Storage area for poisons is locked. Furniture and equipment are sufficient, age appropriate and in good repair. The playground equipment and outdoor activity space is maintained and in good condition with adequate cushioning material. Children's toilets, hand washing facilities are sanitary. Rooms are safe and clean. Food is prepared at the elementary school cafeteria and storage containers for solid waste are covered. Drinking water is available both indoors and outside. Measures are taken to keep facility free of insects and rodents. Staff subject to a criminal record clearance or exemption are associated to the facility. No excluded individuals are present. Teacher-child ratios are maintained and adequate supervision was observed during today’s inspection. First Aid/CPR credentials were reviewed and expire on 8/11/2020. Sign in/sign out sheets are maintained. Children’s records were reviewed to ensure proper forms are located within each child’s file. Staff records contain documentation of education, training, and/or experience. Menus are posted.

Hours of operation are 8:00 – 3:00pm, Monday through Friday.

Incidental Medical Services (IMS) policy was discussed. Incidental Medical Services (IMS) are currently being provided. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

CONTINUED ON LIC809-C
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019
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 4
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: STONE RIDGE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 243808779
VISIT DATE: 11/19/2019
NARRATIVE
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LPA provided Director with information regarding providing incidental medical services to children, the CDSS Provider Information Notices (PINs) communication system, and some important resources and information links offered on the CDSS website.

An exit interview was conducted with Director, Kim Tolbert. A copy of this report must remain in the facility for public review.

Per Chapter 1, Division 12, Title 22 of the California Code of Regulations, the following deficiencies were observed during today's visit (see LIC809-D):

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: STONE RIDGE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 243808779
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/19/2019
Section Cited

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Plan of operation. Any proposed changes in the plan of operation that affect services to children shall be subject to departmental approval prior to implementation and shall be reported as specified in Section 101212. This requirement was not met as evidenced by LPA observation of Child #1’s file and Director
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statement that they did not have an IMS plan for Child #1. This is a potential risk to the health, safety or personal rights of children in care.
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Type B
12/19/2019
Section Cited

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Admission Procedures. (e) At the time of acceptance of each child into care…the licensee shall give each...authorized representative a copy of the Notification of Parents' Rights (LIC 995 [8/02]). (1) The licensee shall request the child’s...authorized representative to sign and date the...LIC 995.
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The bottom portion of this form must be kept in the child's file. This requirement was not met as evidenced by LPA observation of children’s files not having a signed copy of the LIC 995. This is a potential risk to the health, safety or personal rights of children in care.
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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: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:
DATE: 11/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/19/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: STONE RIDGE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 243808779
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/19/2019
Section Cited

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Employees or volunteers at day care center; immunization requirements; records; exemptions. Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against...measles.
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This requirement was not met as evidenced by LPA observation of staff files. The file of Staff #1 did not contain documentation that this person received their MMR vaccination. This is a potential risk to the health, safety or personal rights of children in care.
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Type B
12/19/2019
Section Cited

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Personnel requirements. (3) The good physical health of each volunteer who works in the center shall be verified by: (B) Results of a test for tuberculosis performed not more than one year prior to or seven days after initial presence in the center. This requirement was not met as evidenced by LPA observation
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of Director’s file which contained a TB result from 2016. Director stated to LPA that she has been employed at this facility since 2018. This is a potential risk to the health, safety or personal rights of children in care.
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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: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:
DATE: 11/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/19/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4