500309781-11-6-2019-04-CC-DMEO-BHP28R-20191106161045

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 500309781
Report Date: 11/06/2019
Date Signed: 11/06/2019 04:10:55 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:	METHODIST TINY TOTS		FACILITY NUMBER:	500309781
ADMINISTRATOR:	DESAIRE, RENEE		FACILITY TYPE:	850
ADDRESS:	850 16TH STREET		TELEPHONE:	(209) 525-8687
CITY:	MODESTO	STATE: CA	ZIP CODE:	95354
CAPACITY:	46	CENSUS: 23	DATE:	11/06/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Joni Cisowski		TIME COMPLETED:	04:30 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 unannounced annual inspection was conducted today by Licensing Program Analysts (LPAs) Diane Mercado and Claudia Henley. LPAs met with Director Joni Cisowski and toured the facility, both indoors and outdoors. There are no bodies of water on site. Snacks are provided to children in care. Lunch is brought from home and is properly labeled and stored. Firearms/weapons are not allowed or stored on premises. All children are under supervision, including visual supervision, of a teacher at all times. There is a ratio of one teacher supervising no more than 12 children in attendance. Disinfectants, cleaning solutions and other dangerous items shall be inaccessible to children. No poisons were observed during today’s visit. All materials and surfaces accessible to children are toxic free. All toilets, hand washing, and bathing facilities are in safe and sanitary operating conditions. All floors are clean and safe. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. All food is protected from contamination, and contaminated food is discarded immediately. Solid waste storage vessels, including moveable bins, have tight-fitting covers on, are in good repair. Uncontaminated drinking water is available both indoors and outdoors. Water bottles are brought from home and are properly labeled with each child’s name. Playground equipment is in good condition, free of sharp, loose, or pointed parts. Outdoor activity space surface is maintained in a safe condition and is free of hazards. Areas around high climbing equipment and slides have cushioning material to absorb falls. Community Care Licensing (CCL) shall notify a licensee to immediately terminate the employment of, or to remove/bar any person with specified convictions or for other reasons. The licensee shall comply with the notice. The facility has a new director and CCL does not have all required forms. Director stated sent forms in January to CCL old mailing address. At least one person trained in CPR and Pediatric first-aid is present when children are at the facility or at off-site activities. The person, who signs the child in/out, is responsible for the child, uses their full legal signature and records the time of day. Childrens records were reviewed and one child was missing immunizations. Child's admission agreement is available for review. Required CCL forms are posted on parent's board. Hours of Operation Monday-Friday 7:00 A.M.-6:00 P.M. Continued 809-C

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Diane Mercado	TELEPHONE: (559) 341-6334
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019

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: METHODIST TINY TOTS	FACILITY NUMBER: 500309781
	VISIT DATE: 11/06/2019

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

This facility does not provide Incidental Medical Services (IMS). Director is aware if children in care need IMS in the future to contact CCL. The following information regarding Americans with Disability Act (ADA) was provided: US Department of Justice toll free ADA Information line at (800) 514-0301(voice) and (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm for Commonly Asked Questions about Child Care Centers and the ADA.

An exit interview was conducted with Director, Joni Cisowski.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations the following deficiency is cited (see the attached 809-D). Copy of appeal Rights were provided to Director.

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: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Diane Mercado	TELEPHONE: (559) 341-6334
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019

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: METHODIST TINY TOTS	FACILITY NUMBER: 500309781
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/06/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/08/2019 Section Cited	1 2 3 4 5 6 7	Immunizations (g) The licensee shall document each child's immunizations and shall maintain such documentation in the center for as long as the child is enrolled. This requirement was not met as eveidenced by:
	8 9 10 11 12 13 14	Based on observation of child #1 recored review missing immunization records.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Diane Mercado	TELEPHONE: (559) 341-6334
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3