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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543808497
Report Date: 09/29/2021
Date Signed: 09/29/2021 02:41:12 PM

Document Has Been Signed on 09/29/2021 02:41 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:MITCHELL, ANNIE R.FACILITY NUMBER:
543808497
ADMINISTRATOR:ANDY DI MEOFACILITY TYPE:
850
ADDRESS:2121 E. LAURA STREETTELEPHONE:
(559) 622-3145
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY: 24TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
09/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Amy SullivanTIME COMPLETED:
03:00 PM
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On 09/29/2021 Licensing Program Analyst (LPA) Ruby Ocegueda conducted an unannounced Annual Required Inspection for the preschool license. LPA met with Site Supervisor Isabel Lopez, Margaret McLain, Early Childhood Education Lead (ECE) staff and Amy Sullivan Preschool Program Coordinator. LPA toured the facility facility indoors and outdoors. Days and hours of operation are 8:00 AM - 11:00 AM and 12:00 PM – 3:00 PM and facility follows the traditional school schedule. This facility has an approved playground waiver as the facility shares the play yard with the Transitional Kindergarden class.

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, lose or pointed parts. Playground equipment is in safe condition, free of sharp, lose or pointed parts. While inspecting the play yard, LPA Ocegueda observed a holes next to the storm drain to the right of the play yard and several areas in the play yard where there was indentations of approximately 4-6 inches deep from where the grass and cement path ways met. LPA observed a child from the TK classroom trip on the cement. All toilets and handwashing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe. Breakfast and lunch are prepackaged and delivered from the onsite elementary cafeteria. LPA observed that there were two waste storage containers that did not have have tight fitting covers on them. This observation was reviewed with staff. Drinking water is available both indoors and outdoors. Areas around high climbing equipment, swings and slides have cushioning material to absorb falls. All materials and surfaces accessible to children are toxic free.

SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2021
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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: MITCHELL, ANNIE R.
FACILITY NUMBER: 543808497
VISIT DATE: 09/29/2021
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The facility is free of flies, insects and rodents. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have received a criminal record clearance or exemption. No individuals excluded by the Department are allowed to be present. Capacity and limitations as specified on the license are being maintained. At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at offsite activities. The name of the child care center director or fully-qualified staff designated to act in the director’s absence has been reported to the Department. All children are under supervision, including visual supervision, of a teacher at all times. Facility maintains a ratio of one teacher supervising no more than 12 children in care. LPA reviewed a sample of children’s files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child. LPA reviewed a sample of staff files and observed files were complete with documentation of meeting qualification requirements, immunization records for pertussis and measles and current documentation of completed mandated reporter training. Menus are posted at least one week in advance where an authorized representative can view them.

Incidental Medical Services (IMS) are currently being provided. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.



LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide 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 1, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D) Licensee was provided a copy of their appeal rights.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
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Document Has Been Signed on 09/29/2021 02:41 PM - It Cannot Be Edited


Created By: Ruby Ocegueda On 09/29/2021 at 02:18 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: MITCHELL, ANNIE R.
FACILITY NUMBER: 543808497

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/29/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/27/2021
Section Cited
CCR
101238.2(d)(2)

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Outdoor Activity Space d)The surface of the outdoor activity space shall be maintained:
(2)Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard. This requirement was not met as evidenced by: observation. LPA observed holes and areas of deep indentions which could cause tripping hazzards in the play yard.
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ECE staff and Preschool Coordinator stated that a work order would be submitted and photos would be submitted to the Department by POC date: 10/27/2021.
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ECE staff confirmed the observation. This poses a potential risk to the health, safety and or personal rights of 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:Michael Duarte
LICENSING EVALUATOR NAME:Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE:
DATE: 09/29/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2021


LIC809 (FAS) - (06/04)
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