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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503808634
Report Date: 09/18/2023
Date Signed: 09/18/2023 01:16:52 PM


Document Has Been Signed on 09/18/2023 01:16 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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:SEQUOIA PRESCHOOL ACADEMYFACILITY NUMBER:
503808634
ADMINISTRATOR:GUTHMILLER, JANETFACILITY TYPE:
850
ADDRESS:1308 COFFEE ROADTELEPHONE:
(209) 526-2273
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:30CENSUS: 13DATE:
09/18/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Laura JordanTIME COMPLETED:
01:30 PM
NARRATIVE
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On 09/18/2023, Licensing Program Analyst (LPA) Valerie Mireles conducted an unannounced case management inspection for the preschool license. A census was taken and LPA toured the facility, inside and outside.

During today’s inspection, LPA observed animal feces mixed in with the playground mulch which is accessible to children during outdoor play, which poses a potential risk for children in care. During today's inspection, animal feces was removed from the playground area.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809-D)

Exit interview conducted with the Site Supervisor, Laura Jordan.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Cynthia BrannonTELEPHONE: (559) 650-7884
LICENSING EVALUATOR NAME: Valerie MirelesTELEPHONE: (559) 341-5431
LICENSING EVALUATOR SIGNATURE:
DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2023
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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Document Has Been Signed on 09/18/2023 01:16 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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: SEQUOIA PRESCHOOL ACADEMY
FACILITY NUMBER: 503808634

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/02/2023
Section Cited
CCR
101223(2)

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PERSONAL RIGHTS: The licensee shall ensure that each child is accorded the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. Site Supervisor stated that animal feces have been an
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Site Supervisor Laura Jordan stated that she will have staff check three times daily and keep a logsheet. Laura will conduct a quality control check. Will also use water bottles, and place litter boxes outside of the facility grounds.
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ongoing problem due to neighbor's feeding cats. They recently changed from wood chips to black bark, which has helped but not eliminated the problem. This ongoing problem poses a potential risk for children in care.
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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: Cynthia BrannonTELEPHONE: (559) 650-7884
LICENSING EVALUATOR NAME: Valerie MirelesTELEPHONE: (559) 341-5431
LICENSING EVALUATOR SIGNATURE:
DATE: 09/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2023
LIC809 (FAS) - (06/04)
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