515405496-10-21-2021-13-CC-MMAZ-C7ZSS3-20211021140716

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 515405496
Report Date: 10/21/2021
Date Signed: 10/21/2021 05:18:11 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 II		FACILITY NUMBER:	515405496
ADMINISTRATOR:	EVERETT, KELLI		FACILITY TYPE:	850
ADDRESS:	1191 LIVE OAK BLVD.		TELEPHONE:	(530) 674-7595
CITY:	YUBA CITY	STATE: CA	ZIP CODE:	95991
CAPACITY:	54	CENSUS: 12	DATE:	10/21/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Kelli Fox		TIME COMPLETED:	02:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 10/21/21 at 12:43PM a Required Annual inspection was made to the facility by Licensing Program Analyst (LPA), Mikah Martinez and Kirk Marks and met with Kelli Fox formerly Kelli Everett. The facility file was reviewed prior to this inspection. A review of the personnel report on 10/12/21 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. The facility’s operating hours are 7AM-5PM, Mon-Fri. The facility was toured at 1:10PM time inside and outside and the floor and yard plan submitted by the licensee were verified. The Director stated no firearms or weapons are stored on site and none were observed. There are no pools. The items which could pose a danger to children (such as disinfectants, cleaning solutions and medications) are inaccessible to children. Poisons are locked in a staff cleaning closet in the building. Furniture and equipment are in good condition and free of hazards. The outdoor activity space was cushioned with bark and free of hazards. Toilets and sinks are in sanitary condition and operating properly. The facility floors were clean and safe. The kitchen/food preparation area is clean, and free of litter or rodents. Food is properly stored and free of contamination. Trash cans have tight fitting lids. Drinking water is available to children both inside by water bottle and drinking dispenser and outside by water jug. The facility was free of flies, insects and rodents. The facility has a working carbon monoxide detector. During today's inspection, staffing ratios were being met and there were 12 children were being supervised by 3 teachers/aides. Children are not left without visual supervision at any time. The facility was operating within the licensed capacity. At least one staff member present during the visit (S1) possessed current CPR and First Aid certifications. The sign in/out sheet was reviewed, and representatives are using full signatures and recording the time. Staff are provided on-the-job training, including sanitation and universal precautions. Children with symptoms of illness are not accepted, and children who become ill during the day are isolated in the Directors Office. At 1:14PM 12 Children's files were reviewed and contained emergency identification forms, however some were missing immunizaitons, personal rights, and medical assessments. Three staff records were reviewed at 12:57PM, and contained health screening forms, proof of mandated reporter training, and proof of immunization's. 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(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Mikah Martinez	TELEPHONE: (530) 895-4014
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021

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: 10/21/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101220(a)

Child's Medical Assessments

(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 3 out of 12 childrens files were missing medical assessments. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/26/2021
	Plan of Correction
1 2 3 4	Licensee plans to obtain Medical Assessments (physicians report) into licensing on 11/26/21.

Type B

Section Cited

CCR

101220.1(g)

Immunizations

(g) The licensee shall document each child's immunizations and shall maintain such documentation in the center for as long as the child is enrolled. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 3 out of 12 childrens files were missing immunizations. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/26/2021
	Plan of Correction
1 2 3 4	Licensee plans to obtain Immunizations for 3 children and submit them to licensing on 11/26/21.

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: Erin Virrueta	TELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Mikah Martinez	TELEPHONE: (530) 895-4014
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: 10/21/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101223(b)(1)

Personal Rights

(1) The center shall give each authorized representative a copy of the Personal Rights form (LIC 613A [9/96]). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 6 out of 12 children were missing the above document. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/26/2021
	Plan of Correction
1 2 3 4	The licensee will obtain completed documents for 6 children regarding Personal Rights and submit copies to licensing by 11/26/21.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Erin Virrueta	TELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Mikah Martinez	TELEPHONE: (530) 895-4014
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021

LIC809 (FAS) - (06/04)

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