500319202-4-27-2022-04-CC-LGAN-CDVUBE-20220427152612

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 500319202
Report Date: 04/27/2022
Date Signed: 04/27/2022 03:26:41 PM

Document Has Been Signed on 04/27/2022 03:26 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:	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: 22	DATE:	04/27/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Site Supervisor - Brenda Henley		TIME COMPLETED:	03:40 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 04/27/2022, Licensing Program Analyst (LPA) Luisa Gavoutian, conducted an unannounced Annual Inspection. LPA met with Site Supervisor Brenda Henley, who accompanied LPA on a tour of the facility, indoors and outdoors. This is an AM/PM half day program which operates on a traditional school year schedule. The morning session is 8:00 a.m. to 11:00 a.m. and the afternoon session is 11:30 a.m. to 2:30 p.m., Monday through Friday. This facility is located on the Hughson Elementary School campus and operates in Room 1. 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. Site Supervisor stated there was a child safety gate at the entrance of the facility's kitchen, preventing children from accessing, but it kept falling off and was removed. Site Supervisor stated the children know not to go in the kitchen area. LPA inspected the kitchen as it was accessible during today's inspection and observed the following: three bottles of lotion and one container of hand sanitizer on the counter to the left of the sink, four spray bottles of disinfectant spray on the counter to the right of the sink, accessible water heater in the bottom cabinet, three containers of Clorox cleaner disinfectant wipes in the bottom cabinet across from the sink. Site Supervisor removed all hazardous items, except the water heater, and made them inaccessible to children in care. No poisons were observed during the inspection. LPA observed the north carpeted area of the classroom contained new children's items stored and not being used by the children in care. LPA did not observe a child safety gate making the area inaccessible, but Site Supervisor stated that the area, including the children's loft, are not being used at this time. (Continued on LIC 809-C)

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Luisa Gavoutian	TELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022

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 04/27/2022 03:26 PM - It Cannot Be Edited

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101238(a)

Buildings and Grounds

(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in that cobwebs were observed on the classroom's windows and blinds which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/11/2022
	Plan of Correction
1 2 3 4	Site Supervisor stated the blinds and windows will be cleaned and photographs will be submitted to CCL by 05/11/2022.

Type B

Section Cited

CCR

101238(g)

Buildings and Grounds

(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in disinfectants, toiletries, and water heater were accessible as described in LIC809 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/11/2022
	Plan of Correction
1 2 3 4	Site Supervisor removed the disinfectants and toiletries during today's inspection and made them inaccessible. The water heater is to be made inaccessible and a photograph shall be submitted to CCL by 05/11/2022.

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: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Luisa Gavoutian	TELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/27/2022 03:26 PM - It Cannot Be Edited

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) 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 influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. 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 staff were missing record of all immunizations and two were missing record of influenza which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/27/2022
	Plan of Correction
1 2 3 4	Site Supervisor stated that documentation of immunizations will be obtained and copies sent to CCL by 05/27/2022.

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. 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 four out of four staff did not complete the mandated reporter training which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/12/2022
	Plan of Correction
1 2 3 4	Site Supervisor stated that staff will complete the mandated reporter training during the professional development days prior to the new school year and copies of the certificates shall be submitted to CCL.

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: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Luisa Gavoutian	TELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/27/2022 03:26 PM - It Cannot Be Edited

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(g)(1)

Personnel Requirements

(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure. 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 two of the four staff records did not contain a physician's report or TB test results which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/27/2022
	Plan of Correction
1 2 3 4	Site Supervisor stated staff shall obtain health screenings and TB tests and documentation shall be sent to CCL by 05/27/2022.

Type B

Section Cited

CCR

101161(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, the licensee did not comply with the section cited above in a large portion of the classroom is not being used by children as described in LIC 809 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/27/2022
	Plan of Correction
1 2 3 4	Site Supervisor stated the items being stored in the area shall be removed or the Department will be notified to remeasure the classroom to ensure the areas used meet capacity requirements. Documentation shall be submitted by 05/27/2022.

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: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Luisa Gavoutian	TELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022

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: HUGHSON ELEMENTARY SCHOOL	FACILITY NUMBER: 500319202
	VISIT DATE: 04/27/2022

NARRATIVE

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Site Supervisor stated that she has been trying to get a storage unit to store the children's items and children will not utilize this area until the area has been cleared. LPA informed Site Supervisor that the licensed capacity of 24 was granted based on the measurements of the classroom and if a portion of the classroom is used for storage, then Licensee must either clear the area or have the classroom remeasured to ensure the areas of the classroom being used meet the minimum 35 square feet requirement per child.

Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. All toilets and handwashing facilities are in safe and sanitary operating condition. LPA observed the bolts on the toilet on the left needed to be shaved down to no more than three threads. All floors are clean and safe. The facility is free of flies, insects and rodents. LPA observed cobwebs in the classroom's windows and on the blinds, which should be cleaned. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. LPA observed that the telephone number of the local health department and information on child passenger restraint systems were not posted near the entrance of the classroom.

Meals are provided by the school cafeteria. 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. LPA observed one garbage can containing food items that was not equipped with a lid. LPA observed the garbage can was emptied between the AM and PM session. LPA observed another garbage can in the classroom available with a tight-fitting lid and LPA and Site Supervisor discussed only using that garbage can for food waste. LPA observed a water cooler is available inside, located right at the entry door of the classroom, but no water is available outside. LPA observed three water fountains in the outdoor play area, which were non-operable. Site Supervisor stated that the children go into the classroom to use the indoor water cooler if they request water while playing outside. Site Supervisor stated the children are accompanied by staff at all times. 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. LPA observed a small area of the wood on the bottom of the outside of the classroom's wall, near the water fountains, was rotting. Site Supervisor stated that it is due to a leak in the water pipe that goes out to water fountains that is causing water damage and the wood to rot. (Continued on LIC 809-C)

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Luisa Gavoutian	TELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022

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: HUGHSON ELEMENTARY SCHOOL	FACILITY NUMBER: 500319202
	VISIT DATE: 04/27/2022

NARRATIVE

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LPA observed exposed wood and sharp edges. Areas around high climbing equipment, swings, 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. All staff receive a criminal record clearance through Hughson Unified School District prior to employment.

LPA reviewed four staff records and found all staff had a valid pediatric CPR/first aid certificate, but staff were unsure if the vendor was EMSA certified. The person who signs the child in/out of the facility uses their full legal signature and records the time of day. LPA 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. LPA observed that all children’s files contained a medical assessment. LPA reviewed four staff files and observed the following: Staff 1 and Staff 2 did not have record of measles, pertussis, and influenza, and Staff 3 and Staff 4 did not have record of influenza; none had completed mandated reporter training; Staff 1 and Staff 2 had not completed a Criminal Record Statement (LIC 508); Staff 1 and Staff 2 did not have a health screening or a test for tuberculosis; Staff 1 and Staff 2 did not have a completed employee's rights form (LIC 9052).

This facility provides Incidental Medical Services- IMS. LPA 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 (Continued on LIC 809-C)

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Luisa Gavoutian	TELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022

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: HUGHSON ELEMENTARY SCHOOL	FACILITY NUMBER: 500319202
	VISIT DATE: 04/27/2022

NARRATIVE

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LPA and Site Supervisor 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, 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 Brenda Henley.

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.

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Luisa Gavoutian	TELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/27/2022 03:26 PM - It Cannot Be Edited

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101238.2(d)(2)

The surface of the outdoor activity space shall be maintained: (2) Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above as there was rotting wood outside accessible to children as described in LIC 809 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/27/2022
	Plan of Correction
1 2 3 4	Site Supervisor stated the wood shall be repaired and a photograph will be submitted to CCL by 05/27/2022.

Section Cited


	Deficient Practice Statement
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	POC Due Date:
	Plan of Correction
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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: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Luisa Gavoutian	TELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022

LIC809 (FAS) - (06/04)

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