543810067-5-20-2019-04-CC-MDUE-BCCRHE-20190520130213

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 543810067
Report Date: 05/20/2019
Date Signed: 05/20/2019 01:02:22 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:	WEST PUTNAM PS-PUSD		FACILITY NUMBER:	543810067
ADMINISTRATOR:	REBECCA ORTEGA-ORTIZ		FACILITY TYPE:	850
ADDRESS:	1345 W PUTNAM AVE		TELEPHONE:	(559) 782-7280
CITY:	PORTERVILLE	STATE: CA	ZIP CODE:	93257
CAPACITY:	24	CENSUS: 0	DATE:	05/20/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Preschool Director - Rebecca Ortiz		TIME COMPLETED:	11:45 AM

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	A prelicensing visit was conducted on this date by LPAs Michael Duarte and Pete Espinoza who met with Preschool Director Rebecca Ortiz. The center is located on the premises of West Putnam Elementary School located at 1345 W Putnam in Porterville. The licensee is requesting a capacity of 24 for the preschool program. This program will operate the traditional school year, Monday thru Friday from 7:30AM to 5:30 PM. Breakfast, lunch, snack will be provided and prepared in the cafeteria kitchen on site. There is a sink with hot water inside kitchen area to use for food preparation. Ill children and staff will utilize the bathroom marked for staff use. Ill children will be isolated in the nurses office. Room measurements taken and reviewed with Preschool Director. There is one classroom labeled classroom # 7 that will be used by preschool children. The total inside preschool area measured 879 square feet which will accommodate the requested capacity. There is adequate storage space available for children's belongings. The facility is waiting for funding to go thru in July 2019 to purchases new furniture for the facility. Outdoor storage available for toys and equipment in a nearby classroom, and toys and equipment are age appropriate. Outdoor measurements were taken on this date total 4,536 square feet which exceeds the amount of space needed for the requested capacity. There is adequate shade available in the outdoor activity area. The applicant is using wood chips for cushioning under the outdoor climbing structure. There are 3 toilets and 2 sinks/hand washing fixtures in the children's bathrooms which will accommodate the requested capacity. There is a drinking water fountain the classroom and a Igloo with disposable cups will be used outdoor drinking water. Continued on next page LIC 809-C

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Michael Duarte	TELEPHONE: (559) 243-4588
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2019

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: WEST PUTNAM PS-PUSD	FACILITY NUMBER: 543810067
	VISIT DATE: 05/20/2019

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The fire clearance has been received and approved for 24 preschool children.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

The following items must be completed prior to issuing a license 07/15/2019.
1. Facility will notify LPA Duarte when classroom is set up with appropriate equipment and furniture.

Pending a final file review and completion of above items, a recommendation will be made to license the above facility for a capacity of 24 preschool children.
Please update LIC 500, LIC 610, LIC 308, Facility Sketch upon licensure.

The following documents should be posted at the facility:
* PUB 269- Child passenger restraint systems poster 101225(f) Transportation
* Pub 393- Notification of Parents Rights 101218.1(c) Admission Procedures
* License 101160(a) License
* Menus 101227(a)(6) Food Services
* LIC 613A- Personal Rights form 101223(b)(2) Personal Rights
* LIC 610- Disaster Plan 101174(a)
* LIC 9148- Earthquake Preparedness Checklist 101174(b)

To order forms, etc. visit our website at www.ccld.ca.gov.

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Michael Duarte	TELEPHONE: (559) 243-4588
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2019

LIC809 (FAS) - (06/04)

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