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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543808579
Report Date: 12/02/2019
Date Signed: 12/02/2019 11:10:56 AM

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:WM. R. BUCKLEY ELEMENTARY STATE PRESCHOOLFACILITY NUMBER:
543808579
ADMINISTRATOR:BEAN, KRISTIFACILITY TYPE:
850
ADDRESS:2573 W. WESTFIELD AVE.TELEPHONE:
(559) 788-6412
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY:24CENSUS: 16DATE:
12/02/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Julianne Hurtado, School SecretaryTIME COMPLETED:
11:15 AM
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(3) LPA Pete Espinoza made an unannounced Annual/Random inspection. LPA met with Julianne Hurtado, School Secretary. There are no bodies of water and/or firearms allowed or stored on the premises of a child care center. All children are under visual supervision, of a teacher at all times. Disinfectants, cleaning solutions, poisons and other dangerous items shall be inaccessible to children. All materials and surfaces accessible to children are toxic free. Medications are in a safe place inaccessible to children. Furniture and equipment are in good condition. Children eat lunch in school cafeteria. Uncontaminated drinking water is available both indoors and outdoors. Menus are posted at least one week in advance. 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, swings, and slides have cushioning material to absorb falls. Staff records contain appropriate, documentation of education credits. As a condition for employment, criminal record clearance for all staff are kept and maintained by the Burton Elementary School District Administrative Office. At least one person trained in CPR and Pediatric first-aid is present when children are at the facility or at off-site activities. The person, who signs the child in/out uses their full legal signature and records the time of day. Child's admission agreement is available for review.
Director provided proof required immunizations (Pertussis/Measles/Influenza) and/or written declaration declining flu shot AND certificate of completion for Mandated Reporter Training for all staff present at facility at time of visit.
Operating hours are Mon-Fri 8:00 AM – 3:00 PM
Incidental Medical Services (IMS) policy was discussed. Incidental Medical Services (IMS) are currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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.
NO DEFICIENCIES OBSERVED IN THE AREAS INSPECTED DURING TODAY’S VISIT.
LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Peter EspinozaTELEPHONE: 661-644-8231
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2019
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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