500319202-3-17-2020-04-CC-GBAA-BMSND4-20200317102144

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 500319202
Report Date: 03/17/2020
Date Signed: 03/17/2020 10:21:49 AM

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:	HUGHSON ELEMENTARY SCHOOL		FACILITY NUMBER:	500319202
ADMINISTRATOR:	ERIC PETERSEN		FACILITY TYPE:	850
ADDRESS:	7201 E. WHITMORE AVENUE		TELEPHONE:	(209) 883-0798
CITY:	HUGHSON	STATE: CA	ZIP CODE:	95326
CAPACITY:	24	CENSUS: 15	DATE:	03/17/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Brenda Henley		TIME COMPLETED:	10:45 AM

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 March 17, 2020 an annual required inspection was conducted by Licensing Program Analyst (LPA) Ginny Badhesha. LPA met with Site Supervisor Brenda Henley and toured the facility inside and outside, as shown on the facility sketch. Present today was four staff members and 14 preschool children. Preschool classroom is located in a portable on the Hughson Elementary School grounds. This facility operates a morning and afternoon class during the traditional school year. Days and hours are Monday through Friday from 8:00am to 11:00am and 11:30am to 2:30pm. No bodies of water present. Firearms/weapons are not allowed or stored on premises. All children present receive direct visual supervision at all times. 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. There is adequate heating, lighting and ventilation. Preschool provides snacks that are prepared at the Hughson Elementary School and delivered daily. 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 under/around high climbing equipment and slides have sufficient bark cushioning material to absorbs falls. Licensee does not exceed the conditions, limitations, and capacity specified on the license. Before working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have a clearance or exemption through Hughson Unified 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. (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: 03/17/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2020

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: HUGHSON ELEMENTARY SCHOOL	FACILITY NUMBER: 500319202
	VISIT DATE: 03/17/2020

NARRATIVE

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Staff records contain appropriate documentation. Children files included all required documents. At least one person trained in Pediatric CPR/First and 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.

This facility provides Incidental Medical Services(IMS). LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records.

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 Site Supervisor Brenda Henley 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.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINS), Quarterly Updates, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Gagandip Badhesha	TELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2020

LIC809 (FAS) - (06/04)

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