503605506-10-18-2022-04-CC-AGIN-CKBSD2-20221018134624

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 503605506
Report Date: 10/18/2022
Date Signed: 10/18/2022 01:46:57 PM

Document Has Been Signed on 10/18/2022 01:46 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:	CHATOM STATE PRESCHOOL		FACILITY NUMBER:	503605506
ADMINISTRATOR:	NUNES, SANDRA		FACILITY TYPE:	850
ADDRESS:	7221 CLAYTON ROAD		TELEPHONE:	(209) 664-8003
CITY:	TURLOCK	STATE: CA	ZIP CODE:	95380
CAPACITY:	24	CENSUS: 16	DATE:	10/18/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Sandra Nunes		TIME COMPLETED:	02:00 PM

NARRATIVE

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On 10/18/22 Licensing Program Analyst (LPA) Araceli Gibson, conducted an unannounced annual inspection. LPA met with Teacher/Director, Sandra Nunes Chatom State Preschool operates Monday through Friday and has two sessions AM that runs 8:00 AM -11:00 AM and PM which runs 11:45 AM to 2:45 PM. Today’s census was 16 children present for the PM session. LPA toured the facility, both indoors and outdoors to inspect areas accessible to children in care. This year the school year started 08/16/22 and ends on 05/26/22.

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.

Playground, furniture and equipment are in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe but has been advised to and monitored for hazards, and or muddy surfaces. All toilets and handwashing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe. Lunch is for both sessions and is served and prepared in the school cafeteria. All food is protected against contamination and any contaminated food is discarded immediately. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors. Water fountains are located indoors and outdoors for preschool children to consume. Areas around high climbing equipment, swings and slides have cushioning material to absorb falls. LPA Gibson advised that maintenance use the blower for this area more frequently to maintain a nice clean walking surface for children and to preserve the turf area. The facility is free of flies, insects and rodents. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. As a condition of employment for is for all staff to have a fingerprint clearance through Chatom Union School District 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. 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. Capacity and limitations as specified on the license are being maintained. Continue 809C

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Araceli Gibson	TELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022

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 10/18/2022 01:46 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: CHATOM STATE PRESCHOOL	FACILITY NUMBER: 503605506
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/18/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101220(b)(2)

Child's Medical Assessments

(b) The medical assessment shall provide the following: (2) Results of a test for tuberculosis. 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 (Child #2 and Child #4) Two out of 6 children's file reviewed did not have TB results, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/01/2022
	Plan of Correction
1 2 3 4	Teacher/Director agrees to submit proof of TB results and clearance by either testing or assessment for Child 2 and Child 4 by POC 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: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Araceli Gibson	TELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022

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

FACILITY NAME: CHATOM STATE PRESCHOOL	FACILITY NUMBER: 503605506
	VISIT DATE: 10/18/2022

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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. The preschool is maintaining signing children in/out of the facility by authorized representatives at the site. All children are under supervision, including visual supervision, of a teacher at all times. Facility maintains a ratio of one teacher supervising no more than 12 children in care while 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. LPA reviewed medical assessment and found 2 out 6 children files were missing TB assessment (See 809D).

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. All staff completed mandated reporter training AB1207 in file. Menus are posted at least one week in advance where an authorized representative can view them.

Incidental Medical Services (IMS) is on file no children is current utilizing the IMS plan at this time. 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, the following deficiencies is being cited: (see next page, 809 D) Licensee was provided a copy of their appeal rights.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Araceli Gibson	TELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022

LIC809 (FAS) - (06/04)

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