543801789-10-16-2019-04-CC-DMEO-BGZSRH-20191016140621

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 543801789
Report Date: 10/16/2019
Date Signed: 10/16/2019 02:06:27 PM

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:	JEFFERSON PRESCHOOL		FACILITY NUMBER:	543801789
ADMINISTRATOR:	DORIA, CHERI		FACILITY TYPE:	850
ADDRESS:	333 N. WESTWOOD		TELEPHONE:	5595628523
CITY:	LINDSAY	STATE: CA	ZIP CODE:	93247
CAPACITY:	24	CENSUS: 20	DATE:	10/16/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Elizabeth Rodriguez Menatdo		TIME COMPLETED:	02:20 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	An unannounced Annual inspection was conducted today by Licensing Program Analysts (LPAs) Diane Mercado and Robert Gutierrez. LPAs met with Teacher Elizabeth Rodriguez Mentado and toured the facility, both indoors and outdoors. There are no bodies of water on site. Firearms/weapons are not allowed or stored on premises. All children are under supervision, including visual supervision, of a teacher at all times. Disinfectants, cleaning solutions and other dangerous items are inaccessible to children. No poisons were observed during today’s inspection. All materials and surfaces accessible to children are toxic free. All toilets, hand washing, and bathing facilities are in safe and sanitary operating conditions. All floors are clean and safe. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. 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. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. Playground equipment is in good condition, free of sharp, loose, or pointed parts. Outdoor activity space surface is maintained in a safe condition and is free of hazards. Areas around high climbing equipment and slides have cushioning material to absorb falls. Community Care Licensing (CCL) shall notify a licensee to immediately terminate the employment of, or to remove/bar any person with specified convictions or for other reasons. The licensee shall comply with the notice. Fingerprints are conducted through Lindsay Unified school district as a condition of employment. Staff records contain appropriate, documentation of education credits. Staff records contain documentation of education, training, and/or experience. Fire drills are being conducted and documented. At least one person trained in CPR and Pediatric first-aid is present when children are at the facility or at off-site activities. Child's admission agreement is available for review. This is an AM/PM half day program which operates on a traditional school year schedule. The morning session is 7:45am to 10:45am and the afternoon session is 11:45am to 2:45pm, Monday through Friday. Required CCL forms are posted on parent's board. This facility provides Incidental Medical Services – IMS. Currently no children require medication. Continued on 809-C

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Diane Mercado	TELEPHONE: (559) 341-6334
LICENSING EVALUATOR SIGNATURE:	DATE: 10/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2019

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, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: JEFFERSON PRESCHOOL	FACILITY NUMBER: 543801789
	VISIT DATE: 10/16/2019

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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.

Per Chapter 1, Division 12, Title 22 of the California Code of Regulations no deficiencies are observed today. Site Visit Notice posted on the parent board.

Exit interview was conducted with Teacher Elizabeth Rodriguez Mentado.

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Diane Mercado	TELEPHONE: (559) 341-6334
LICENSING EVALUATOR SIGNATURE:	DATE: 10/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2019

LIC809 (FAS) - (06/04)

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