503604250-11-19-2019-04-CC-RMAS-BJ3P2F-20191119095551

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 503604250
Report Date: 11/19/2019
Date Signed: 11/19/2019 09:55:57 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:	ALBERTA MARTONE PREFORMAL CENTER		FACILITY NUMBER:	503604250
ADMINISTRATOR:	SIEGEL, ANN		FACILITY TYPE:	850
ADDRESS:	1413 POUST ROAD		TELEPHONE:	(209) 576-4077
CITY:	MODESTO	STATE: CA	ZIP CODE:	95351
CAPACITY:	24	CENSUS: 18	DATE:	11/19/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Kimbra Draper		TIME COMPLETED:	10:15 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

An unannounced annual random inspection was conducted today by Licensing Program Analyst (LPA) Rene Mancinas JR. LPA met with Coordinator, Kimbra Draper. This is a single classroom facility housed on the Martone Elementary School campus. LPA toured the facility, both indoors and outdoors to inspect areas accessible to children in care. There are no bodies of water on site. Firearms/weapons are not allowed or stored on premises. All children are under supervision, including visual supervision, of a teacher at all times. Disinfectants, cleaning solutions and other dangerous items shall be inaccessible to children. No poisons were observed during today’s inspection. All materials and surfaces accessible to children are toxic free. Medications, when stored at the facility, are kept in an area inaccessible to children. Children restrooms are located in the classroom for children to use. All toilets, hand washing, and bathing facilities are in safe and sanitary operating conditions. All floors are clean and safe. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. Solid waste storage vessels, including moveable bins, have tight-fitting covers on, are in good repair.

Uncontaminated drinking water is available both indoors and outdoors. Menus are posted at least one week in advance, where an authorized representative can view them. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. Playground equipment is in good condition, free of sharp, loose, or pointed parts.

CCL shall notify a licensee to immediately terminate the employment of, or to remove/bar any person with specified convictions or for other reasons. The licensee shall comply with the notice. Before working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have a clearance or exemption and have been associated to the facility.

(Continued on 809-C)

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene Mancinas	TELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

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: ALBERTA MARTONE PREFORMAL CENTER	FACILITY NUMBER: 503604250
	VISIT DATE: 11/19/2019

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
26
27
28
29
30
31
32

At least one person trained in CPR and Pediatric first-aid is present when children are at the facility or at off-site activities. The person, who signs the child in/out, is responsible for the child, uses their full legal signature and records the time of day. Child's admission agreement is available for review.

HOURS OF OPERATION: School-Year Schedule; Monday through Friday; 07:00am to 05:30pm.

Meals/Snacks are prepped in the school’s main cafeteria and served to the children in the classroom.

Required CCL forms are posted in a prominent place and are readily available for parents/public view. LPA informed Coordinator of the Community Care Licensing Division website, which provides access to Provider Information Notices (PINs), Quarterly Updates, Mandated Reporter Training, Safe Sleep information, Lead Poisoning information, forms available for print, and information regarding Department regulations.

Per Chapter 1, Division 12, Title 22 of the California Code of Regulations no deficiencies are observed today. Notice of Site Visit to be posted for 30 days from today’s inspection. Exit interview was conducted with Coordinator, Kimbra Draper.

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene Mancinas	TELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2