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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103808850
Report Date: 11/02/2021
Date Signed: 11/02/2021 03:28:11 PM

Document Has Been Signed on 11/02/2021 03:28 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:STARTING BLOCKS CHILDREN'S ACADEMYFACILITY NUMBER:
103808850
ADMINISTRATOR:ERMELINDA PEREZFACILITY TYPE:
850
ADDRESS:3315 E SIERRA MADRETELEPHONE:
(559) 227-7036
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY: 39TOTAL ENROLLED CHILDREN: 39CENSUS: 10DATE:
11/02/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Blanca GomezTIME COMPLETED:
03:45 PM
NARRATIVE
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On 11/02/2021, Licensing Program Analyst (LPA) Nancy Her conducted an unannounced case management inspection. The purpose of this inspection was to address deficiencies discovered during an investigative inspection.

During today’s visit, LPA reviewed staff files. LPA observed that staff members still have not completed and/or renewed mandated reporter training.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D) Licensee was provided a copy of their appeal rights.

Exit interview conducted and report was reviewed with the facility representative Blanca Gomez.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Nancy Her
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2021
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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Document Has Been Signed on 11/02/2021 03:28 PM - It Cannot Be Edited


Created By: Nancy Her On 11/02/2021 at 03:16 PM
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: STARTING BLOCKS CHILDREN'S ACADEMY
FACILITY NUMBER: 103808850

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/02/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/09/2021
Section Cited
HSC
1596.8662(b)(1)

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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided...and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
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Facility will have staff members complete mandated reporter training via www.mandatedreporterca.com and submit certificate of completion to Fresno Community Care Licensing by 11/09/2021.
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This requirement is not met as evidenced by:

During today's inspection, upon staff record review, there were staff members who had not completed and/or renewed mandated reporter training which poses a potential health, safety or personal rights risk to persons 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:Duane Matsubara
LICENSING EVALUATOR NAME:Nancy Her
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2021


LIC809 (FAS) - (06/04)
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