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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515405496
Report Date: 08/01/2019
Date Signed: 08/19/2019 12:24:56 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:FUSION PRESCHOOL ACADEMY IIFACILITY NUMBER:
515405496
ADMINISTRATOR:EVERETT, KELLIFACILITY TYPE:
850
ADDRESS:1191 LIVE OAK BLVD.TELEPHONE:
(530) 674-7595
CITY:YUBA CITYSTATE: CAZIP CODE:
95991
CAPACITY:54CENSUS: 24DATE:
08/01/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Dante WaltersTIME COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Laura Chavez conducted a case management inspection to the facility for the purpose of obtaining a copy of the Child Care Roster previously requested on 6/19/2019. During today's inspection facility Director Dante Walters was unable to locate the roster.

All licensing reports are public information and must be made available upon request for at least three years. A copy of the appeal Right's
Notice of Site Visit shall be posted for 30 days from today's visit.

The following Title 22 deficiency was cited during today's inspection. See LIC 809-D.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2019
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: FUSION PRESCHOOL ACADEMY II
FACILITY NUMBER: 515405496
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/01/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/06/2019
Section Cited
HSC
1596.841
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Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall be
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Facility Director agrees to provide a current copy of the roster of children in care to CCLD on or by 8/6/2019.

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available to the licensing agency upon request.

This requirement was not met as evidenced by: Facility Director unable to locate the roster of 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: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2019
LIC809 (FAS) - (06/04)
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