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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203810226
Report Date: 11/15/2024
Date Signed: 11/15/2024 03:22:39 PM

Document Has Been Signed on 11/15/2024 03:22 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:NISHIMOTO STATE PRESCHOOLFACILITY NUMBER:
203810226
ADMINISTRATOR/
DIRECTOR:
ERIK FALKEFACILITY TYPE:
850
ADDRESS:26460 MARTIN STTELEPHONE:
(559) 664-8110
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 11DATE:
11/15/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Site Supervisor Adriana BorregoTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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On 11/15/2024 Licensing Program Analyst (LPA) Xona Xayavong and Licensing Program Manager (LPM) Kari McWilliams, conducted an unannounced Annual Random Inspection for the preschool license. LPA and LPM met with Site Supervisor Adriana Borrego and toured the facility indoors and outdoors. Days and hours of operation are Monday through Friday, AM class: 7:55 am to 11:00 am and PM class: 11:55 am to 3:00 pm. Site Supervisor stated facility operates during traditional school year.

All poisons are kept in a locked storage area. 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. During playground inspection, LPA and LPM observed multiple holes on the cushioning pad at the play structure area. LPA and LPM observed chipped paint on the stair area on the play structure and fading paint on the hanging bar. LPA and LPM observed cracked covering on the climbing chain. Areas around high climbing equipment, swings and slides have cushioning material to absorb falls. All toilets and handwashing 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 off center premises. Menus are posted at least one week in advance where an authorized representative can view them.

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SUPERVISORS NAME: Kari McWilliams
LICENSING EVALUATOR NAME: Xona Xayavong
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 11/15/2024 03:22 PM - It Cannot Be Edited


Created By: Xona Xayavong On 11/15/2024 at 02:37 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: NISHIMOTO STATE PRESCHOOL

FACILITY NUMBER: 203810226

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 11/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238(a)
Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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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 and LPM observed multiple holes on the cushioning pad at the play structure area. LPA and LPM observed chipped paint on the stair area on the play structure and fading paint on the hanging bar. LPA and LPM observed cracked covering on the climbing chain. Head Custodian stated a work order has been made for a replacement of the cushioning pad but facility is still in the process of approving a bid by a contractor.
POC Due Date: 12/16/2024
Plan of Correction
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Site Supervisor stated she will refer playground structure issues to Director to place a work order. Site Supervisor stated she will provide updates as work order begin until completion.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Kari McWilliams
LICENSING EVALUATOR NAME:Xona Xayavong
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2024


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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: NISHIMOTO STATE PRESCHOOL
FACILITY NUMBER: 203810226
VISIT DATE: 11/15/2024
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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 and LPM 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 and LPM 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 and LPM 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 and LPM discussed Reporting Requirements as outlined in the regulations (Section 101212).

Site Supervisor 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 and LPM verified that the lead testing was completed in accordance with the Written Directives outlined in PIN 21-21.1-CCP. LPA and LPM referred Site Supervisor to the Department website for lead: www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information.

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SUPERVISORS NAME: Kari McWilliams
LICENSING EVALUATOR NAME: Xona Xayavong
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024
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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: NISHIMOTO STATE PRESCHOOL
FACILITY NUMBER: 203810226
VISIT DATE: 11/15/2024
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LPA and LPM discussed safe sleep regulations with Site Supervisor 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 and LPM also informed licensee Site Supervisor 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.

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/.

Site Supervisor 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 conducted and report was reviewed with Site Supervisor Adriana Borrego. Appeal rights were provided. Per Title 22, Division 12, Chapter 1 of the California Code of Regulations, the following deficiency is being cited: (see next page on 809-D).

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: Kari McWilliams
LICENSING EVALUATOR NAME: Xona Xayavong
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024
LIC809 (FAS) - (06/04)
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