503808388-9-25-2019-04-CC-RMAS-BGCPEN-20190925111524

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 503808388
Report Date: 09/25/2019
Date Signed: 09/25/2019 11:15:29 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:	KIRSCHEN CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	503808388
ADMINISTRATOR:	SIEGEL, ANN		FACILITY TYPE:	850
ADDRESS:	1900 KIRSCHEN DRIVE		TELEPHONE:	(209) 575-8547
CITY:	MODESTO	STATE: CA	ZIP CODE:	95351
CAPACITY:	20	CENSUS: 16	DATE:	09/25/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Amber Mar		TIME COMPLETED:	11:20 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 inspection was conducted today by Licensing Program Analysts (LPAs) Rene Mancinas JR and Ginny Badhesha. LPAs met with Teacher, Amber Mar. This is single-classroom facility housed on the Kirschen Elementary School campus. LPAs toured the facility, both indoors and outdoors to inspect areas accessible to children in care. LPAs observed a fenced playground area, which included preschool play structures consisting of steps and slides, a sand box, and a tricycle track area. LPAs observed safe play equipment and adequate shading on this accessible outdoor play area during today’s inspection. Outdoor activity space surface is maintained in a safe condition and is free of hazards. Firearms/weapons are not allowed or stored on premises. All children are under supervision, including visual supervision, of a teacher at all times. No poisons were observed during today’s inspection. Medications, when stored at the facility, are locked and stored in area inaccessible to day care children. Restroom is located in the classroom and designated for children to use. Restroom was clean and toilets and hand washing sinks were in operable conditions. 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. LPAs observed a fire extinguisher, smoke alarm, and carbon monoxide present in the facility in accordance with regulation requirements.

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.

Child's admission agreement is available for review. Meals are prepared off site by the main school’s cafeteria and served to the children in the classroom.

HOURS OF OPERATION: School-Year schedule/Monday through Friday: 08:00am to 03:30pm, with half-day/part-time options available. (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: 09/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019

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: KIRSCHEN CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 503808388
	VISIT DATE: 09/25/2019

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

Required CCL forms are posted on parent's board. Incidental Medical Services (IMS) policy was discussed. LPA informed staff 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 California Code of Regulations Title 22 Division 12 Chapter 1; no deficiencies are being cited. Exit interview conducted with Teacher, Amber Mar. Notice of Site Visit to be posted for 30 days.

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene Mancinas	TELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2