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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103801249
Report Date: 04/19/2024
Date Signed: 04/19/2024 12:15:01 PM

Document Has Been Signed on 04/19/2024 12:15 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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:ST. HELEN'S JUNIOR KINDERGARTEN PRESCHOOLFACILITY NUMBER:
103801249
ADMINISTRATOR/
DIRECTOR:		ANNA BANUELOSFACILITY TYPE:
850
ADDRESS:4888 E. BELMONT AVENUETELEPHONE:
(559) 251-4846
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 9DATE:
04/19/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Staff #1TIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
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On 04/19/2024, Licensing Program Manager (LPM) Cynthia Brannon and Licensing Program Analyst (LPA) Aurelio Mendoza arrived at the facility to conduct an unannounced case management visit. LPM Brannon and LPA Mendoza met with Staff #1. A tour of the facility inside and outside was conducted and census was taken.

The nature of today’s visit was to follow up and obtain a complete Director Change Packet for the new administrator, Principal Patrick Dodd. During today’s visit directions were provided and items outlined that need to be accounted for the Director Change Packet to be accepted and processed by Department of Social Services. Before conducting this inspection, LPM reviewed files for this facility and another facility that the principal oversees and neither file contained the required documentation.

Additionally, during today’s inspection and walkthrough with Staff #1, LPA reviewed items on the children’s play yard that as a preventive measure will benefit from upkeep to ensure children’s safety while they are using the play area. LPA reviewed with staff the requirement to ensure debris is removed from play yard before children are outside, broken toys are to be removed, and tree roots that interfere with children’s play area are also to be removed. Direction was provided to staff to submit written documentation when the black plastic barrier that encircles the cushioned area is replaced/repaired to reduce tears/cracks that may become an endangerment to children in care, climbing structure shall also need to have a sticker stating the appropriate ages of children that can utilize the play structure, and the cushioning requirement for adequate padding under all of the fall zones to assist in preventing children from sustaining serious injuries from falls. Furthermore during today's visit it was reviewed that a children's restroom sink faucet was taped and routine service can ensure children have access to wash stations; it is noted that the facility still has plenty of access to working sinks and toilets to comply with Child Care Licensing capacity requirements.

Continued on 809-C

SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Aurelio Mendoza
LICENSING EVALUATOR SIGNATURE: DATE: 04/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/19/2024
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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Document Has Been Signed on 04/19/2024 12:15 PM - It Cannot Be Edited


Created By: Aurelio Mendoza On 04/19/2024 at 10:27 AM
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: ST. HELEN'S JUNIOR KINDERGARTEN PRESCHOOL
FACILITY NUMBER: 103801249

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/19/2024
Section Cited
CCR
101170(e)(1)

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CRIMINAL RECORD CLEARANCE: Section 101170(e)(1) and H&S 1596.871- Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review shall obtain a clearance or criminal record exemption.
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Site Supervisor Anna Banuelos directed staff #2 to go complete Live Scan process with LIC 9163 that was provided by LPM Brannon and LPA Mendoza today 04/19/2024. Staff #2 was directed to follow up with facility and DSS and submit proof that Live Scan was completed today 04/19/2024.
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A review of staff records indicated that staff #2 did not utilize DSS's Live Scan Form to
be properly cleared to work onsite. This poses a potential risk to children.
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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:Cynthia Brannon
LICENSING EVALUATOR NAME:Aurelio Mendoza
LICENSING EVALUATOR SIGNATURE:
DATE: 04/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2024


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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: ST. HELEN'S JUNIOR KINDERGARTEN PRESCHOOL
FACILITY NUMBER: 103801249
VISIT DATE: 04/19/2024
NARRATIVE
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Also, during today’s visit at approximately 9:30 am Staff #2 arrived to work and LPM Brannon and LPA Mendoza attempted to verify that Staff #2 was cleared for background however employee record review yielded that Staff #2 was provided an incorrect Live Scan Form prior to starting employment.

CRIMINAL RECORD CLEARANCE: Section 101170(e)(1) & H&S 1596.871-Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review shall obtain a clearance or criminal record exemption.

Appeal Rights were provided to facility representative. A Notice of Site Visit was given and must remain posted for 30 days. Exit interview conducted with Staff #1.

Per the California Code of Regulations, Title 22, Division 12, Chapter 1, the following citation is issued on page LIC 809D.

SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Aurelio Mendoza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2024
LIC809 (FAS) - (06/04)
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