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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515405496
Report Date: 08/16/2019
Date Signed: 08/19/2019 12:02:10 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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: 18DATE:
08/16/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Kelli EverettTIME COMPLETED:
11:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Laura Chavez conducted a case management inspection to the facility for the purpose of following up on the licensee's failure to provide proof of corrections on deficiencies cited on 6/19/2019. Deficiencies cited included Reporting Requirements, specifically that the the licensee failed to report that infants were temporarily moved into the preschool building due to a flea infestation in the infant facility. Also, Outdoor Activity Space, specifically that there was an inadequate amount of cushioning material around the climbing structures. During today's inspection LPA conducted a tour of the outdoor play area, LPA observed additional cushioning material placed under and around the climbing equipment. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

The following violation of the California Code of Regulations, Title 22; Division 12, was cited:see LIC809-D. Appeal Rights were provided.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2019
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: 08/16/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/02/2019
Section Cited
CCR
101212(d)(1)(C)
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Reporting Requirements. Any unusual incident or child absence that threatens the physical or emotional health or safety of a child shall be reported to the Department within 24 hours of the occurrence.

This requirement was not met as evidenced by: the licensee failing to report that infants
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The licensee agrees to provide training in the responsibility of submitting reports to Community Care Licensing. Training shall be provided to staff responsible for reporting unusual incidents. Training shall include watching the video offered through the Department's website;
https://ccld.childcarevideos.org/
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were temporarily moved into the preschool building due a flea infestation in the infant facility.
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The plan of correction (POC) shall include a written statement on how staff will apply information provided in video. The POC shall be submitted to CCLD on or before 9/2/2019. The written plan shall include names of staff who were provided the training.
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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: 08/16/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2019
LIC809 (FAS) - (06/04)
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