500317738-4-21-2022-04-CC-LGAN-CDPTZ4-20220421150942

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 500317738
Report Date: 04/21/2022
Date Signed: 04/21/2022 03:10:01 PM

Document Has Been Signed on 04/21/2022 03:10 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	CA STATE UNIVERSITY STANISLAUS CDC		FACILITY NUMBER:	500317738
ADMINISTRATOR:	SMITH, STEPHANI		FACILITY TYPE:	850
ADDRESS:	ONE UNIVERSITY CIRCLE		TELEPHONE:	(209) 667-3036
CITY:	TURLOCK	STATE: CA	ZIP CODE:	95382
CAPACITY: 30	TOTAL ENROLLED CHILDREN: 39	CENSUS: 12	DATE:	04/21/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Director - Stephani Smith		TIME COMPLETED:	03:20 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 04/21/2022, Licensing Program Analysts (LPAs) Luisa Gavoutian and Stephanie Vega-Gonzalez, conducted an unannounced Annual Inspection. LPAs met with Director, Stephani Smith, who accompanied LPAs on a tour of the facility, indoors and outdoors. Hours of operation are Monday – Friday, 8:00 a.m. – 4:00 p.m. 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. 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. LPA observed several shelves that were not anchored and recommended that Licensee anchor the shelves to prevent tipping. All toilets and handwashing facilities are in safe and sanitary operating condition. All floors are clean and safe. The facility is free of flies, insects and rodents. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. LPAs observed that preschool children were utilizing the infant classroom for meals and for napping. The infant program is currently on inactive status and no infants are using the classroom at this time. However, the infant classroom has not been licensed for preschool use. If Licensee would like to use the infant classroom for providing care and supervision of preschool children, Licensee must submit an updated form LIC 200A, update the facility's plan of operation, and the room must be inspected and licensed for use prior to Licensee using the classroom. (Continued on LIC 809-C)

SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Luisa Gavoutian
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022

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 04/21/2022 03:10 PM - It Cannot Be Edited

Created By: Luisa Gavoutian On 04/21/2022 at 02:06 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: CA STATE UNIVERSITY STANISLAUS CDC	FACILITY NUMBER: 500317738
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101229.1(b)

Sign In and Sign Out

(b) The person who brings the child to, and removes the child from, the center shall sign the child in/out. 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 in that two children were not signed in/out per regulation as described in LIC 809 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/23/2022
	Plan of Correction
1 2 3 4	Director stated that she shall ensure that the sign-in/out sheets are checked daily each morning to ensure each child is signed in and out appropriately. Director shall submit this plan in writing to CCL by 05/23/2022.

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 observation and interview, the licensee did not comply with the section cited above as care and supervision for preschool children was being provided in the infant classroom as described in LIC 809 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/23/2022
	Plan of Correction
1 2 3 4	Director stated that they will refrain from using the infant classroom and will only utilize the licensed preschool classrooms. Director shall submit this plan in writing to CCL by 05/23/2022.

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:

Alice Juarez

LICENSING EVALUATOR NAME:

Luisa Gavoutian

LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022

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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: CA STATE UNIVERSITY STANISLAUS CDC	FACILITY NUMBER: 500317738
	VISIT DATE: 04/21/2022

NARRATIVE

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This facility provides AM/PM snacks and children bring their own meals from home. All kitchen, food preparation, and storage areas are clean, free of litter/rubbish and rodents/vermin. 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. Uncontaminated drinking water is available both indoors and outdoors. Menus are posted at least one week in advance where an authorized representative can view them.

Playground equipment is in safe condition, free of sharp, loose, or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. LPAs observed an area of the black plastic border surrounding the outdoor play yard that is used to keep the wood chips inside the play area had a crack, exposing sharp edges. Licensee stated a work order will be placed to have that section of the border replaced. Areas around high climbing equipment and slides have cushioning material in the form of wood chips to absorb falls.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

At least one person trained in Pediatric CPR and First Aid is present when children are at the facility or at offsite activities. LPAs reviewed sign-in/out sheets and found Child 1 had been signed in and out for future dates 04/22/2022 and 04/25/2022 and Child 2 was present today but had not been signed in; Child 2 had been signed in for 04/20/2022, but not signed out. LPAs reviewed a sample of children’s files and observed files were complete with contact information for authorized representatives or others who can assume responsibility if the authorized representative cannot be reached. LPAs reviewed 10 children's files and found one was missing results of tuberculosis or a risk assessment and two were missing the signed consent for emergency medical treatment. LPAs reviewed 10 staff files and observed files were complete with immunization records for influenza, pertussis, and measles, and current documentation of completed mandated reporter training. LPAs found Staff 1’s personnel record did not contain record of a health screening.
(Continued on LIC 809-C)

SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Luisa Gavoutian
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022

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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: CA STATE UNIVERSITY STANISLAUS CDC	FACILITY NUMBER: 500317738
	VISIT DATE: 04/21/2022

NARRATIVE

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This facility provides Incidental Medical Services- IMS. LPAs reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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

LPAs and Director discussed the Community Care Licensing (CCL) website (www.ccld.ca.gov) which provides 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 Chapter 1, Division 12, Title 22 of the California Code of Regulations, the following deficiencies were found: (see LIC809-D). Exit interview conducted and report was reviewed with the facility representative Stephani Smith.

A notice of site visit was given and must remain posted for 30 days.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Luisa Gavoutian
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022

LIC809 (FAS) - (06/04)

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