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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515405919
Report Date: 10/25/2019
Date Signed: 10/25/2019 04:55:39 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 (INFANT)FACILITY NUMBER:
515405919
ADMINISTRATOR:EVERETT, KELLIFACILITY TYPE:
830
ADDRESS:1191 LIVE OAK BLVD.TELEPHONE:
(530) 437-8216
CITY:YUBA CITYSTATE: CAZIP CODE:
95991
CAPACITY:12CENSUS: 2DATE:
10/25/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:10 PM
MET WITH:Dante WaltersTIME COMPLETED:
05:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Martinez conduced an unannounced visit and met with Director Dante Walters. At 4:15 LPA entered the infant room with Dante and it was expressed that two infants were sleeping. It was observed that the staff S1 was near the front entrance. As the Director began speaking, one child C1 woke up. S1 went and picked up C1 and brought the child to the kitchen for snack. Two minutes later C2 woke up and began crying. LPA observed S1 go to the sleeping area and pick up C2 and take the child to the kitchen area.

The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.

Reports citing Type A violations are to be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file.

SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Mikah MartinezTELEPHONE: (530) 895-4014
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2019
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 (INFANT)
FACILITY NUMBER: 515405919
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/28/2019
Section Cited

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Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times. Under no circumstances shall ANY infant be left unattended. This requirement was not met as evidenced by; Based on observation by the LPA it was observed there was only one staff with one awake and one sleeping infant
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in two separate rooms of the facility which left one infant sleeping without visual observation and supervision. This is an immediate health and safety risk to 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: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Mikah MartinezTELEPHONE: (530) 895-4014
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2019
LIC809 (FAS) - (06/04)
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