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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203810221
Report Date: 11/07/2022
Date Signed: 11/07/2022 02:37:43 PM

Document Has Been Signed on 11/07/2022 02:37 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:WASHINGTON STATE PRESCHOOLFACILITY NUMBER:
203810221
ADMINISTRATOR:ADALBERTO HERNANDEZFACILITY TYPE:
850
ADDRESS:509 E SOUTH STTELEPHONE:
(559) 674-6705
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 26DATE:
11/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:21 AM
MET WITH:ESMERALDA DIAZTIME COMPLETED:
10:05 AM
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On 11/7/2022, Licensing Program Analysts (LPAs) Stephanie Vega-Gonzalez and Joseph Pacheco conducted an unannounced case management inspection. LPA met with Lead Teacher Esmeralda Diaz and toured the facility inside and outside and a census was taken for classroom one (15) and classroom two (11). The purpose of today's inspection was to inspect new play equipment that was installed in the outdoor play area for use for the preschool children.

LPA observed two slides and adequate woodchips surrounding the play structure. The play structure has two shades installed to provide adequate shade. Mature trees provide additional shade. Children access the slide by walking up stairs. Wood chips are being used for cushioning. Adequate cushioning around the slide and play structure was observed to absorb falls. Manufacturer specifications state the new play equipment is suitable for children ages 2-5 years old. Outdoor activity space surface is maintained in a safe condition and is free of hazards. Playground equipment is in good condition, free of sharp, loose, or pointed parts. LPA reminded Lead teacher Esmeralda Diaz to ensure that manufacturer’s instructions are followed at all times when using the equipment and reminded Lead teacher Esmeralda Diaz to discuss with staff best practices for maintaining visual supervision at all times when children are playing outdoors.

Effective today, 11/07/2022, the facility may begin using the new outside play equipment for preschool children.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, no deficiencies are cited.

Exit interview conducted and report was reviewed with Lead teacher Esmeralda Diaz.

This report shall be made available to the public upon request. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100
SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Stephanie Vega-Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2022
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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