503601681-3-27-2023-04-CC-AGIN-CQBRKH-20230327130535

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 503601681
Report Date: 03/27/2023
Date Signed: 03/27/2023 01:05:41 PM

Document Has Been Signed on 03/27/2023 01:05 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:	WILSON ELEMENTARY		FACILITY NUMBER:	503601681
ADMINISTRATOR:	NUNES, HEIDI		FACILITY TYPE:	850
ADDRESS:	201 WILSON AVE		TELEPHONE:	(209) 574-8452
CITY:	MODESTO	STATE: CA	ZIP CODE:	95351
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 21	CENSUS: 19	DATE:	03/27/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Kimbra Draper		TIME COMPLETED:	01:15 PM

NARRATIVE

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On 03/27/22 Licensing Program Analyst (LPA) Araceli Gibson, conducted an unannounced annual inspection. LPA met with Kimbra Draper ECE Coordinator. LPA toured the facility, both indoors and outdoors to inspect areas accessible to children in care. Wilson Elementary runs a regular school year program beginning on 8/09/22 ending on 05/24/23 operating Monday through Friday with 11:30 AM. Wilson Elementary operates with two waiver for shared outdoor activity space and shared bathrooms with the elementary children.

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. The surface of the outdoor activity space and playground equipment is maintained in a safe condition. There are wood chips surrounding the high impact play structures for added safety. Floors in the facility are clean and safe. Breakfast is provided by Wilson Elementary and is served to the preschool child in the classroom. All food is protected against contamination and any contaminated food is discarded immediately. LPA advised to monitor solid waste storage containers and ensure they have tight-fitting covers and are in good repair in bathrooms, and outdoor by activities spaces preschool children have access to. Drinking water is available both indoors and outdoors. The facility is free of flies, insects and rodents. Facility has one or more functioning carbon monoxide detectors it’s a dual component for smoke detection as well and it meets statutory requirements. Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have received a criminal record clearance or exemption from Modesto City School District. Upon notification from the Department, the licensee will comply and act immediately to terminate the employment of, remove from the facility or bar from entering the facility for any person it is deemed necessary while the Department considers granting or denying an exemption. During today’s inspection of the bathrooms for preschool children it was stated by staff bathrooms were relocated a few months ago this indicated capacity and limitations as specified on the license was not being maintained as waiver had permitted. A plan of correction was cited (see 809D for further) continue on 809C

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Araceli Gibson
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023

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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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: WILSON ELEMENTARY	FACILITY NUMBER: 503601681
	VISIT DATE: 03/27/2023

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At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at offsite activities. The name of the child care center director or fully-qualified teacher designated to act in the director’s absence has been reported to the Department. Authorized Representative are signing children in/out of the facility and is being maintained. All children are under supervision, including visual supervision, of a teacher at all times while virtual learning format. Facility maintains a ratio of one teacher supervising no more than 12 children in care when in person learning is conducted. LPA 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 and medical assessment. LPA 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. Menus are posted at least one week in advance where an authorized representative can view them.

Incidental Medical Services (IMS) is current but there are no children utilizing it at this time. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA 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.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, one deficiency is cited during today’s inspection.

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Araceli Gibson
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/27/2023 01:05 PM - It Cannot Be Edited

Created By: Araceli Gibson On 03/27/2023 at 12:49 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: WILSON ELEMENTARY	FACILITY NUMBER: 503601681
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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, interviews and record review, the licensee did not comply with the section cited above Licensee was operating with a waiver for shared bathrooms on campus. The bathrooms for the preschool children were relocated to a different part of the campus without an inspection from CCLD, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/28/2023
	Plan of Correction
1 2 3 4	Licensee agrees to relocate back to previous location as originally approved per waiver. Licensee agrees to provide evidence of step stools, paper towels, and soap dispensers accessible to the preschool children.

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:

Juvenal Moctezuma

LICENSING EVALUATOR NAME:

Araceli Gibson

LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023

LIC809 (FAS) - (06/04)

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