503600291-5-8-2023-04-CC-YFIO-CRMSUB-20230508141052

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 503600291
Report Date: 05/08/2023
Date Signed: 05/08/2023 02:11:05 PM

Document Has Been Signed on 05/08/2023 02:11 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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	EMPIRE HEAD START		FACILITY NUMBER:	503600291
ADMINISTRATOR:	CENTENO, CONSUELO		FACILITY TYPE:	850
ADDRESS:	5201 FIRST ST		TELEPHONE:	(209) 527-9884
CITY:	EMPIRE	STATE: CA	ZIP CODE:	95319
CAPACITY:	20	CENSUS:	DATE:	05/08/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Consuelo Centeno		TIME COMPLETED:	02:30 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	On 5/8/2023 an unannounced Annual inspection was conducted today by Licensing Program Analysts, (LPAs) Yesenia Fierro and Araceli Gibson. LPAs met with Director, Consuelo Centeno and toured the facility, both indoors and outdoors. The LPAs observed all required licensing forms to be posted in a visible location for authorized representatives to view them. A census was taken and there were 14 day care children present. This facility runs a half day program. The hours of operation are from 8:00AM to 12:00PM breakfast and lunch is provided; prepackaged meals are provided by the school cafeteria. There is no swimming pool or other bodies of water on the premises. Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Floors in the facility are clean and safe. There is adequate heating and ventilation for safety and comfort. All materials and surfaces accessible to children are toxic free. The licensee has a complete first aid kit, including bandages, scissor, thermometer, gloves and a first aid manual. All toilets and handwashing facilities are in safe and sanitary operating condition. Menus are posted at least one week in advance where an authorized representative can view them. All kitchen, food preparation and storage areas are clean, free of litter/rubbish and free of rodents/vermin. All foods/beverages capable of rapid spoiling are stored in covered containers at 45 (F) degrees or less. Drinking water is available both indoors and outdoors. 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. Areas around high climbing equipment, swings and slides have cushioning material to absorb falls. Solid waste storage containers have tight-fitting covers and are in good repair. The facility is free of flies, insects, and rodents. The LPAs did not observe disinfectants, cleaning solutions and other dangerous items to be accessible/inaccessible to children. There were no poisons observed on the premises accessible to children. Licensee is aware that poisons are required to be locked and inaccessible to children. Continue 809-C

SUPERVISOR'S NAME: Rene Mancinas	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Yesenia Fierro	TELEPHONE: (559) 794-0709
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023

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 05/08/2023 02:11 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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: EMPIRE HEAD START	FACILITY NUMBER: 503600291
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101170(e)(2)

Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 101170(f) or 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 staff 1 has a background clearance however staff 1 did not have evidence of associaton to the facility which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/22/2023
	Plan of Correction
1 2 3 4	Director agrees to have staff 1 associated to this facility by plan of correction date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Rene Mancinas	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Yesenia Fierro	TELEPHONE: (559) 794-0709
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023

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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: EMPIRE HEAD START	FACILITY NUMBER: 503600291
	VISIT DATE: 05/08/2023

NARRATIVE

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LPAs reviewed a sample of children’s files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child, medical assessment, and immunizations recorded. LPAs reviewed a sample of staff files and observed files were complete with health screening, immunization records for influenza, pertussis and measles and current documentation of completed mandated reporter training. Currently Empire School District has a waiver for an alternative Mandated Reporter Training which can be found on the CDSS website. Staff records contain documentation of meeting qualification requirements. The name of the childcare center director or fully-qualified teacher(s) designated to act in the director’s absence has been reported to the Department. The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. 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. Capacity and limitations as specified on the license are being maintained. As a condition of employment all staff need to have fingerprint clearance. During today inspections staff 1 was verified to have been background cleared but however was not associated to the facility. (See 809-D) for further.

Incidental Medical Services (IMS) are currently being provided. 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.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

Consuelo Centeno 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. There are no excluded individuals present at this facility. Licensee is aware that upon notice from the Department, any excluded individual must be immediately removed from the facility and prevented from returning to the center or having contact with children in care. The licensee shall comply with the notice. Continue 809-C

SUPERVISOR'S NAME: Rene Mancinas	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Yesenia Fierro	TELEPHONE: (559) 794-0709
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023

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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: EMPIRE HEAD START	FACILITY NUMBER: 503600291
	VISIT DATE: 05/08/2023

NARRATIVE

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LPAs and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide 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.

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.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D) Licensee was provided a copy of their appeal rights.

LPAs Yesenia Fierro and Araceli Gibson informed facility representative Consuelo Centeno that this report dated 05/08/2023 document one Type B citation

Exit interview conducted and report was reviewed with the facility representative Consuelo Centeno

SUPERVISOR'S NAME: Rene Mancinas	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Yesenia Fierro	TELEPHONE: (559) 794-0709
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023

LIC809 (FAS) - (06/04)

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