543801382-4-6-2022-04-CC-PESA-CD8TNF-20220406145240

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 543801382
Report Date: 04/06/2022
Date Signed: 04/06/2022 02:52:48 PM

Document Has Been Signed on 04/06/2022 02:52 PM - It Cannot Be Edited

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:	PORTERVILLE CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	543801382
ADMINISTRATOR:	RODRIGUEZ, BEATRIZ		FACILITY TYPE:	850
ADDRESS:	254 WEST ORANGE		TELEPHONE:	(559) 781-0145
CITY:	PORTERVILLE	STATE: CA	ZIP CODE:	93257
CAPACITY:	75	CENSUS: 27	DATE:	04/06/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Sheila Hernandez, Center Supervisor		TIME COMPLETED:	03:00 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 01/07/2022, Licensing Program Analyst (LPA) Pete Espinoza, conducted an unannounced Annual Inspection. LPA met with Sheila Hernandez, Center Supervisor. LPA toured facility, indoors and outdoors. Hours of operation are Monday – Friday, 7:45 AM. - 2:30 PM. All children are under supervision, including visual supervision, of a teacher at all times. There is a ratio of one teacher supervising no more than 12 children in attendance. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication, and other hazardous items are made inaccessible. No poisons were observed during the inspection. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. All toilets and handwashing facilities are in safe and sanitary operating condition. All floors are clean and safe. The facility is free of flies, insects and rodents. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. All kitchen, food preparation, and storage areas are clean, free of litter/rubbish and rodents/vermin. All food is protected against contamination and any contaminated food is discarded immediately. Solid waste storage containers have tight-fitting covers and are in good repair. Uncontaminated drinking water is available both indoors and outdoors. Menus are posted at least one week in advance where an authorized representative can view them. Playground equipment is in safe condition, free of sharp, loose, or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. Areas around high climbing equipment, swings, and slides have cushioning material in the form of wood chips to absorb falls. (Continued on LIC 809-C)

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Peter Espinoza	TELEPHONE: 661-644-8231
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2022

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 4

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: PORTERVILLE CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 543801382
	VISIT DATE: 04/06/2022

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
26
27
28
29
30
31
32

Criminal Record Clearance for staff are associated to Senaida Garcia Child Development Center (#543801384).

Capacity and limitations as specified on the license are being maintained. The person who signs the child in/out of the facility uses their full legal signature and records the time of day. LPA reviewed a sample of children’s files and observed files were complete with contact information for authorized representatives or others who can assume responsibility if the authorized representative cannot be reached. LPA observed that all children’s files contained a medical assessment. LPA reviewed staff files and observed files were complete with immunization records for influenza, pertussis, and measles, and current documentation of completed mandated reporter training.

This facility does provide Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA and Teacher Director discussed the Community Care Licensing (CCL) website (www.ccld.ca.gov) which provides access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D) Licensee was provided a copy of appeal rights.

A notice of site visit was given and must remain posted for 30 days.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Peter Espinoza	TELEPHONE: 661-644-8231
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2022

LIC809 (FAS) - (06/04)

Page: 2 of 4

Document Has Been Signed on 04/06/2022 02:52 PM - It Cannot Be Edited

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: PORTERVILLE CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 543801382
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/06/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(f)

Personnel Requirements

(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities. 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 8 out of 8 staff files which poses a potential health, safety or personal rights risk to persons in care. All staff CPR Certifications are expired.
	POC Due Date: 05/06/2022
	Plan of Correction
1 2 3 4	Licensee will provide proof of successful completion of CPR Certification for at least two (2) staff. Licensee will send copy of Certification to Fresno Regional Office by 05/06/2022

Type B

Section Cited

CCR

101216(g)(2)

Personnel Requirements

(2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following: 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 8 out of 8 staff files which poses a potential health, safety or personal rights risk to persons in care. Staff files contain Physician's Statement of Health that does not meet Title 22 Regulations - person's physical qualifications to perform the duties to be assigned.
	POC Due Date: 05/06/2022
	Plan of Correction
1 2 3 4	Licensee will submit written statement indicating staff files will contain "Employee Physical Examination" form indicating health screen report is stored at another location and is available for review upon request. Licensee will send written statement to Fresno Regional Office by 05/06/2022.

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: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Peter Espinoza	TELEPHONE: 661-644-8231
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2022

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 04/06/2022 02:52 PM - It Cannot Be Edited

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: PORTERVILLE CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 543801382
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/06/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101221(b)(6)

Child's Records

(b) Each record shall contain information including, but not limited to, the following: (6) A signed copy of the admission agreement specified in Section 101219. 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 10 out of 10 children's files, which poses a potential health, safety or personal rights risk to persons in care. Parental Agreement Form does not meet requirements of Title 22.
	POC Due Date: 05/06/2022
	Plan of Correction
1 2 3 4	Licensee will submit draft of Admission Agreement that contains all requirements of Title 22. Licensee will send draft of Admission Agreement to Fresno Regional Office by 05/06/2022.

Type B

Section Cited

CCR

101221(b)(8)(C)

Child's Records

(C) A signed consent form for emergency medical treatment unless the child's authorized representative has signed the statement specified in Section 101220(f). 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 10 out of 10 children's files, which poses/posed a potential health, safety or personal rights risk to persons in care. Record review indicated no proof of signed Consent for Emergency Medical Treatment for children enrolled in the center.
	POC Due Date: 05/06/2022
	Plan of Correction
1 2 3 4	Licensee will write statement indicating all records for children enrolled will contain Consent for Emergency Medical Treatment (LIC 627) and/or language indicating such as required by Title 22 . Licensee will send written statement to Fresno Regional Office by 05/06/2022.

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: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Peter Espinoza	TELEPHONE: 661-644-8231
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2022

LIC809 (FAS) - (06/04)

Page: 4 of 4