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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503808945
Report Date: 11/06/2019
Date Signed: 11/06/2019 12:22:10 PM

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:SMALL WORLD CHRISTIAN SCHOOLFACILITY NUMBER:
503808945
ADMINISTRATOR:VALVERDE, BENJAMINFACILITY TYPE:
830
ADDRESS:1027 7TH STTELEPHONE:
(209) 523-4388
CITY:MODESTOSTATE: CAZIP CODE:
95354
CAPACITY:20CENSUS: 15DATE:
11/06/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Miriam PadillaTIME COMPLETED:
10:15 AM
NARRATIVE
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LPA's Claudia Henley & Diana Mercado conducted a case management visit today. We were met by Director Miriam Padilla. A tour of the facility was conducted. There were a total of four staff with 15 infants/toddlers.

Upon inspection of the infant playground area, there was two wood pallets stacked up and laying on the ground on the infant playground. Inspection of the infant/toddler classroom, LPA's observed that the infant diaper changing table sink had no water. Staff stated that the water tank was empty.

The following is cited per Title 22 Regulations (see page 2). Appeal Rights left with Ms. Padilla.

Site Visit Notice posted on the parent board. Exit interview was conducted.

SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Claudia HenleyTELEPHONE: (559) 341-5776
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019
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: SMALL WORLD CHRISTIAN SCHOOL
FACILITY NUMBER: 503808945
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/06/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/06/2019
Section Cited

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Infant Care Center Fixtures, Furniture, Equipment and Supplies - Section 101438(h)(4): Infant Tables should while in use, be placed within arm's reach of a sink. :
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This requirement was not met as evidenced by: LPA's observed that the diaper changing table sink in the infant room did not have water. Staff stated that the sink water tank was empty.
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Type B
11/13/2019
Section Cited

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Outdoor Activity Space - Section 101238(d)(1): The surface of the outdoor activity space shall be maintained in a safe condition for the activities
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planned. LPA's observed on the infant playground two wood pallets stacked up sitting on the ground and old torn up pieces of rubber cushioning sections and strips laying against the building
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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: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Claudia HenleyTELEPHONE: (559) 341-5776
LICENSING EVALUATOR SIGNATURE:
DATE: 11/06/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/06/2019
LIC809 (FAS) - (06/04)
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