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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103808802
Report Date: 08/24/2021
Date Signed: 08/24/2021 11:28:41 AM

Document Has Been Signed on 08/24/2021 11:28 AM - 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:FUSD-HAMILTONFACILITY NUMBER:
103808802
ADMINISTRATOR:MATHIES, DEANNAFACILITY TYPE:
850
ADDRESS:102 E. CLINTONTELEPHONE:
(559) 457-3685
CITY:FRESNOSTATE: CAZIP CODE:
93704
CAPACITY: 24TOTAL ENROLLED CHILDREN: 0CENSUS: 17DATE:
08/24/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Debbie SharpTIME COMPLETED:
11:55 AM
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On 8/24/2021 Licensing Program Analyst (LPA) Ruby Ocegueda, conducted an unannounced Annual Required Inspection for the preschool license. LPA met with Site Supervisor, and toured the facility indoors and outdoors. Days and hours of operation are Monday through Friday 8:00 AM – 11:00 AM and 11:30 AM to 2:30 PM.

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, loose or pointed parts. The playground and playground surfaces were inspected today. All toilets and handwashing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe. Meals are prepared off site and brought to the facility for the children. A prepackaged snack is offered to the children. All food is protected against contamination and any contaminated food is discarded immediately. Drinking water is available both indoors and outdoors. Areas around high climbing equipment, swings and slides have cushioning material to absorb falls. 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. Upon notification from the Department, the licensee will comply and act immediately to terminate the employment of, remove from the facility or bar from entering the facility for any person it is deemed necessary while the Department considers granting or denying an exemption. Capacity and limitations as specified on the license are being maintained. Report continued to 809-C.

SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE: DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2021
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: FUSD-HAMILTON
FACILITY NUMBER: 103808802
VISIT DATE: 08/24/2021
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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 Site Supervisor or fully-qualified teacher(s) designated to act in the Site Supervisor absence has been reported to the Department. Parents conduct electronic sign in and out procedures. Site Supervisor verifies each signature as the parents signs the child in on her computer. 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 and medical assessment. LPA reviewed a sample of staff files. LPA observed that S1 was missing physicians report and copy of immunizations records and also observed that S2 was missing proof of required MMR immunization. LPA reminded staff to obtain proof of influenza for this year or complete declination statement for their files. Menus are posted at least one week in advance where an authorized representative can view them.

There is an accepted Incidental Medical Services (IMS), however there are no children utilizing any IMS and is not 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 was cited: (see 809-D). Appeal Rights were provided. An exit interview was reviewed with Site Supervisor Debbie Sharp.

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: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/24/2021 11:28 AM - It Cannot Be Edited


Created By: Ruby Ocegueda On 08/24/2021 at 10:43 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: FUSD-HAMILTON
FACILITY NUMBER: 103808802

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/24/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/21/2021
Section Cited
HSC
1596.7995(c)

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(c) The day care center shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person’s personnel record that is maintained by the day care center. This requirement was not met as evidenced by: record review and interview.
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Site Supervisor will provide proof of missing immunizations to the Department by POC date 9/21/2021.
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During inspection of personell files, LPA observed that S1 was missing proof of immunizations and S2 was missing proof of MMR immunizations. Both staff stated that they had the required proof but was missing from their file today. 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: 08/24/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2021


LIC809 (FAS) - (06/04)
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