203810160-8-3-2021-04-CC-JMOA-C5JVT6-20210803164235

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 203810160
Report Date: 08/03/2021
Date Signed: 08/03/2021 04:42:40 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:	LA VINA STATE PRESCHOOL		FACILITY NUMBER:	203810160
ADMINISTRATOR:	MOISES PEREZ		FACILITY TYPE:	850
ADDRESS:	8594 ROAD 23		TELEPHONE:	(559) 675-4490
CITY:	MADERA	STATE: CA	ZIP CODE:	93637
CAPACITY:	15	CENSUS: 0	DATE:	08/03/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Tina Najarian		TIME COMPLETED:	01:00 PM

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On 08/03/2021, Licensing Program Analyst (LPA) Juvenal Moctezuma conducted an announced prelicensing inspection and met with Director of Early Childhood Education, Tina Najarian. LPA explained the reason of the inspection and a tour of the center was conducted both inside and outside. The center is located on the premises of La Vina Elementary School on 8594 Road 23 in Madera, CA.

The applicant is requesting a preschool capacity of 15 preschool children. This program will operate year round from 6:30 AM to 4:30 PM Monday through Friday. This program will operate in the preschool classroom. The center will provide breakfast, lunch, and an afternoon snack. Food will be provided by the Madera Unified Child Nutrition Services. Food will be delivered to the classroom. Staff will utilize the bathroom located at the school office. Ill children will be isolated in the nurses office and will use a separate bathroom there.

LPA observed that the classroom had age appropriate toys and was observed to be clean & free of toxins. The furniture and equipment inside the classroom appeared to be safe and in good condition. There is adequate storage space available for children's belongings as well.

The cleaning items will be stored in the teachers storage area which will remained closed and locked by a latch that's placed up high. The first aid kit is stored in a high cabinet inside the classroom. The medication will be kept at the nurses office. Tina stated that she will submit proof that there is a working carbon monoxide installed. Tina stated that she will have a sanitation table outside the preschool classroom where parents can sign in/out their children. Staff are going to do wellness checks & temperature checks every morning during pick up and drop off. Health screenings are being conducted by parents before their child gets dropped off through parent square app. Children will be able to wash their hands as soon as they enter the classroom.

Report Continued Onto LIC 809-C

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Juvenal Moctezuma	TELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021

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: LA VINA STATE PRESCHOOL	FACILITY NUMBER: 203810160
	VISIT DATE: 08/03/2021

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Room measurements were taken and reviewed with Tina. The total inside preschool area measured to an approximate 1,048 square feet which will accommodate the requested preschool capacity. There are a total of 16 cots stored in the classroom next to the cubbies. LPA observed plenty of age appropriate toys and enough tables & chairs to meet the requested capacity. The center will provide the bedding/blankets. Tina stated that they are also going to be wash the bedding and sheets every week - Friday. The preschool classroom has a total of 1 toilet and 2 sinks/hand washing fixtures which will accommodate the requested capacity of 15 preschool children. Tina stated that the center will use water jugs and disposable cups for drinking water both indoor and outdoor.

The approximate outside square footage for the preschool area is 11,782 square feet which will accommodate the requested capacity of 15 Preschool Children. LPA observed the outside play area to be fenced all around with 3 mature trees to provide shade. There is a play structure and bike path along with age appropriate toys. LPA also observed a sand box and grass all through the play yard. Tina stated she will get an age sticker on the playground. There is a shed for storage. There is a separate garden area that is also fenced off where children will have access to. Tina stated that teachers are made aware to have visual supervision of children at all times. LPA reminded Tina to make sure they fill up the holes that gophers make to prevent any injuries.

A fire clearance for a total of 15 children was received and granted by the Madera County Fire Department on 07/23/2021

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A Plan of Operation that includes IMS must be submitted to the Department. 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 by 08/17/2021.

Inside Daycare:
· Cup Dispenser
· Proof of Carbon Monoxide.
· Hand Soap for bathroom and classroom sink
· Paper towels

Report Continued Onto LIC 809-C

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Juvenal Moctezuma	TELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021

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: LA VINA STATE PRESCHOOL	FACILITY NUMBER: 203810160
	VISIT DATE: 08/03/2021

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Outside Play Area:
· Shave thread bolts around fence to a recommended size 3 to 4 threads.
· Cover tree roots with more dirt to prevent tripping hazards
· Add more wood chips to the play ground area
· Paint play structure and metal bench since rust and metal are showing
· Get age sticker for play structure
· Cover gopher holes throughout play yard.
· Power wash toys to clean off dust and spider webs.

Pending a final file review and completion of above items, a recommendation will be made to license the above facility for a capacity of 15 preschool children.

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)
* Activity Schedule
* Lead Poisoning brochure

No deficiencies cited during today's visit.
A COPY OF THIS REPORT IS TO REMAIN IN THE FACILITY FOR PUBLIC REVIEW.
THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
To order forms, etc. visit our website at www.ccld.ca.gov

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Juvenal Moctezuma	TELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021

LIC809 (FAS) - (06/04)

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