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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543808691
Report Date: 01/09/2020
Date Signed: 01/09/2020 02:00:35 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:ALPAUGH STATE PS/ALPAUGH U.S.D.FACILITY NUMBER:
543808691
ADMINISTRATOR:HUDSON, ROBERT M.FACILITY TYPE:
850
ADDRESS:5313 ROAD 39TELEPHONE:
(559) 949-8305
CITY:ALPAUGHSTATE: CAZIP CODE:
93201
CAPACITY:24CENSUS: DATE:
01/09/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Nancy RubleTIME COMPLETED:
02:10 PM
NARRATIVE
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Licensing Program analyst (LPA) Rene Mancinas, conducted an unannounced case management inspection. The purpose of today’s inspection was to follow up on facility administrative organization status. LPA met with Director, Nancy Ruble.

LPA informed Nancy that the Department received notification of change in director in 2017. During previous inspections conducted by LPAs, Nancy Ruble has stated she is the Director of the facility. Multiple attempts have been made by the Department to obtain necessary documentation to make such changes in Director. The facility has failed to provide requested supporting documents in order to proceed with the change.

California Code of Regulations Title 22 Division 12 Chapter 1 Section 101212(a)(b) states the following;

(a)Each licensee or applicant shall furnish to the Department reports as required by the Department including, but not limited to, the following:

(b)The name of the child care center director, and any fully qualified teacher(s) designated to act in the child care center director's absence, shall be reported to the Department within 10 days of a change of child care center director or designee(s)

Due to multiple attempts by the Department to collect the documents required to process a change in director request and facility failure to act on such matter in providing the supporting documents, the above deficiency is being cited today. (See 809-D for further). Appeal rights were provided.

This report shall be made readily available upon public request. Notice of Site Inspection to be posted for 30 days from today’s inspection.

SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene MancinasTELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020
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: ALPAUGH STATE PS/ALPAUGH U.S.D.
FACILITY NUMBER: 543808691
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/22/2020
Section Cited

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(a) Each licensee or applicant shall furnish to the Department reports as required by the Department including, but not limited to, the following: (b) The name of the child care center director, and any fully qualified teacher(s) designated to act in the child care center director's
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absence, shall be reported to the Department within 10 days of a change of child care center director or designee(s). This requirement was not met as evidenced by facility failure to produce supporting documents to the Department to process such change. (See 809 for further). This is a potential risk to health, safety, and personal rights of children in care.
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Child Care Office on 01/22/2020. Nancy agreed to bring required documents on 01/22/2020 meeting in order to process director change.

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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: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene MancinasTELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2020
LIC809 (FAS) - (06/04)
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