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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503808634
Report Date: 09/28/2023
Date Signed: 09/28/2023 12:50:39 PM


Document Has Been Signed on 09/28/2023 12:50 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:
09/28/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Laura JordanTIME COMPLETED:
01:30 PM
NARRATIVE
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On 09/28/2023, 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. LPA reviewed staff files.

During today’s inspection, LPA reviewed a sample of staff files and observed files were incomplete, but included health screening, immunization records for influenza, pertussis and measles and current documentation of completed mandated reporter training and Pediatric First Aid. Staff #1’s file was complete, however, was missing Child Abuse Central Index clearance and Staff #2’s file had a completed Criminal Background Clearance Transfer Request Form, but it had not been submitted to Community Care Licensing.

Site Supervisor was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiencies are being cited: (see next page).

Exit interview conducted with the Site Supervisor, Laura Jordan.

SUPERVISOR'S NAME: Cynthia BrannonTELEPHONE: (559) 650-7884
LICENSING EVALUATOR NAME: Valerie MirelesTELEPHONE: (559) 341-5431
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2023
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 09/28/2023 12:50 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: 09/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/02/2023
Section Cited
CCR
101170(e)(2)

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Criminal Record Clearance. Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review shall request a transfer of a criminal record clearance from another facility or Trustline. LPA reviewed clearances and found staff #1 was missing
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Licensee shall ensure all staff is fingerprint cleared and associated prior to working at the facility.
Licensee will obtain full criminal record clearance to include Child Abuse Central Index and submit LIC9182 to CCL by 10/02/2023.
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 Child Abuse Central Index clearance and staff #2 was not associated to the facility. This poses a potential risk to the health, safety, or personal rights of children. A $100 civil penalty to be assesed.
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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: 09/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2023
LIC809 (FAS) - (06/04)
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