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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503602251
Report Date: 11/16/2021
Date Signed: 11/16/2021 03:55:51 PM

Document Has Been Signed on 11/16/2021 03:55 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:TURLOCK CHRISTIAN PRESCHOOL (INF)FACILITY NUMBER:
503602251
ADMINISTRATOR:DE LA MOTTE, HEIDIFACILITY TYPE:
830
ADDRESS:2006 E. TUOLUMNE ROADTELEPHONE:
(209) 669-2192
CITY:TURLOCKSTATE: CAZIP CODE:
95382
CAPACITY: 31TOTAL ENROLLED CHILDREN: 31CENSUS: 15DATE:
11/16/2021
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Director - Heidi de la MotteTIME COMPLETED:
04:10 PM
NARRATIVE
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On 11/16/2021, Licensing Program Analyst (LPA) Luisa Gavoutian, conducted an unannounced Case Management - Annual Continuation Inspection. This visit is a continuation of the annual inspection that was conducted on 10/27/2021. LPA met with Director, Heidi de la Motte, who accompanied LPA on a tour of the facility, indoors and outdoors, and a census was taken. Hours of operation are Monday – Friday, 7:00 a.m. – 6:00 p.m.

On 10/27/2021, LPA observed that there was no sink within arms’ reach of the changing table in the Ladybugs Classroom (one-year-olds). LPA observed the sink was located in the adjacent storage room. Director stated that the classroom has always been set up that way and the facility was licensed that way. Director stated the facility has plans to install a sink in the classroom. Director shall submit proof of a work order or shall submit a waiver request in order to meet regulatory requirements set forth in California Code of Regulations (CCR) Section 101439(h)(4), which states, “(h) Infant changing tables shall: (4) While in use, be placed within arm's reach of a sink.” On 10/27/2021, LPA observed accumulated sand and debris underneath the changing pads of the changing tables. On 11/16/2021, LPA observed the sand and debris had been cleaned.

Menus are posted at least one week in advance where an authorized representative can view them. On 10/27/2021, LPA observed bags of breast milk in the refrigerator that were labeled with the child’s name, but not the date the milk was brought to the facility.
(Continued on LIC 809-C)
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Luisa Gavoutian
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2021
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 11/16/2021 03:55 PM - It Cannot Be Edited


Created By: Luisa Gavoutian On 11/16/2021 at 02:48 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: TURLOCK CHRISTIAN PRESCHOOL (INF)
FACILITY NUMBER: 503602251

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101419.3(a)
Modifications to Infant Needs and Services Plan
(a) The written infant needs and services plan shall be updated at least quarterly, or as often as necessary to assure its accuracy.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in two out of 10 infant files' and five out of five infants enrolled in the toddler component files' needs and services plans were not updated at least quarterly which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/16/2021
Plan of Correction
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Director stated that the needs and services plans will be updated and copies will be submitted to CCL by 12/16/2021.
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:Alice Juarez
LICENSING EVALUATOR NAME:Luisa Gavoutian
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2021


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: TURLOCK CHRISTIAN PRESCHOOL (INF)
FACILITY NUMBER: 503602251
VISIT DATE: 11/16/2021
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The person who signs the child in/out uses their full legal signature and records the time of day. Today, LPA reviewed a sample of children’s files and observed files were complete with contact information for authorized representative and/or others who can assume responsibility if the authorized representative cannot be reached. All children’s files were complete with a medical assessment, 15-minute sleep logs, and LIC 9227. LPA observed two out of 10 records were missing Infant Needs and Services Plans and two out of 10 infant files' and five out of five infants enrolled in the toddler component files' needs and services plans were not updated at least quarterly. On 10/27/2021, LPA reviewed staff files and observed files were complete with health screening, immunization records for influenza, pertussis, and measles, and documentation of completed mandated reporter training. Staff records contain documentation of meeting qualification requirements.

LPA and Licensee discussed the 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 deficiency was found: (see LIC809-D). Exit interview conducted and report was reviewed with the facility representative Heidi de la Motte.

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: 11/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021
LIC809 (FAS) - (06/04)
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