203810160-12-19-2024-04-CC-JROZ-DC4SEC-20241219124832

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 203810160
Report Date: 12/19/2024
Date Signed: 12/19/2024 12:48:50 PM

Document Has Been Signed on 12/19/2024 12:48 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:	LA VINA STATE PRESCHOOL		FACILITY NUMBER:	203810160
ADMINISTRATOR/ DIRECTOR:	MOISES PEREZ		FACILITY TYPE:	850
ADDRESS:	8594 ROAD 23		TELEPHONE:	(559) 675-4490
CITY:	MADERA	STATE: CA	ZIP CODE:	93637
CAPACITY: 15	TOTAL ENROLLED CHILDREN: 15	CENSUS: 7	DATE:	12/19/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:15 AM
MET WITH:	Gill Gaganpreet		TIME VISIT/ INSPECTION COMPLETED:	01:00 PM

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On 12/19/2024 Licensing Program Analyst (LPA) Julio Rodriguez, conducted an unannounced Annual Random Inspection for the preschool license. LPA met with facility representative Gill Gaganpreet and toured the facility indoors and outdoors. Days and hours of operation are Monday through Friday 7:00 a.m. – 4:00 p.m.

No poisons were observed during the inspection. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. 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.

Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Playground equipment is in safe condition, free of sharp, loose or pointed parts. Staff was observed interacting and attending to children in care. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. Outdoor play area is surrounded by bar-link fencing. LPA observed two adjacent gates separating outdoor play area and outside campus. LPA observed child gate lock was damaged on one gate and the adjacent gate was unlocked. Facility representative immediately secured the gate and stated she would place an order to have child safety lock repaired. Areas around high climbing equipment, swings and slides have wood cushioning material to absorb falls. Shade is provided by two large trees located in the playground. All toilets and hand washing facilities are in safe and sanitary operating condition. Facility has one or more functioning carbon monoxide detectors. Floors in the facility are clean and safe. Solid waste storage containers have tight-fitting covers and are in good repair.

Drinking water is available both indoors and outdoors. Drinking water is provided by water dispenser and disposable cups. This facility does provide meals to children, snacks are provided. Food is prepared on site at the school cafeteria. LPA observed menu where an authorized representative can view them but were found to be outdated. Facility representative updated the menu during the visit.

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SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Julio Rodriguez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024

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 12/19/2024 12:48 PM - It Cannot Be Edited

Created By: Julio Rodriguez On 12/19/2024 at 12:14 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: LA VINA STATE PRESCHOOL	FACILITY NUMBER: 203810160
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/19/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101238.2(d)(2)

Outdoor Activity Space

(d) The surface of the outdoor activity space shall be maintained: (2) Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation , the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. LPA observed two adjacent gates separating outdoor play area and outside school campus. LPA observed child gate lock was damaged on one gate and the adjacent gate was unlocked. Facility representative immediately secured the gate and stated she would place an order to have child safety lock repaired.
	POC Due Date: 12/30/2024
	Plan of Correction
1 2 3 4

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Juvenal Moctezuma

LICENSING EVALUATOR NAME:

Julio Rodriguez

LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024

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: LA VINA STATE PRESCHOOL	FACILITY NUMBER: 203810160
	VISIT DATE: 12/19/2024

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Capacity and limitations as specified on the license are being maintained. 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 director or fully-qualified teacher(s) designated to act in the director’s absence has been reported to the Department. All children are under supervision, including visual supervision, of a teacher at all times. Facility meets teacher-child ratios. LPA reviewed a sample of children’s files and observed one child was missing lic627 form; other children 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 and observed files were complete with health screening, immunization records for influenza, pertussis and measles and current documentation of completed mandated reporter training.

LPA discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to resources such as forms, regulations Provider Information Notices (PINs), and Quarterly Updates.

LPA discussed Reporting Requirements as outlined in the regulations (Section 101212).

Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). LPA verified that the lead testing was completed in accordance with the Written Directives outlined in PIN 21-21.1-CCP. LPA referred facility representative to the Department website for lead: www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information.

Continued on 809-C.

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Julio Rodriguez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024

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: LA VINA STATE PRESCHOOL	FACILITY NUMBER: 203810160
	VISIT DATE: 12/19/2024

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LPA discussed safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Facility representative states there are currently no children on medication in the classroom. Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, an updated 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Exit interview was conducted and report was reviewed with facility representative Gill Gaganpreet and appeal rights were provided.

Per Title 22, Division 12, of the California Code of Regulations, the following deficiency is being cited: (see next page).

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: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Julio Rodriguez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024

LIC809 (FAS) - (06/04)

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