240407459-2-28-2025-04-CC-PKVE-DEBT2Y-20250228132132

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 240407459
Report Date: 02/28/2025
Date Signed: 02/28/2025 01:21:50 PM

Document Has Been Signed on 02/28/2025 01:21 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:	ADA GIVENS PRESCHOOL		FACILITY NUMBER:	240407459
ADMINISTRATOR/ DIRECTOR:	MEJIA, MARIA		FACILITY TYPE:	850
ADDRESS:	2900 GREEN STREET		TELEPHONE:	(209) 385-6378
CITY:	MERCED	STATE: CA	ZIP CODE:	95340
CAPACITY: 22	TOTAL ENROLLED CHILDREN: 22	CENSUS: 13	DATE:	02/28/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Maria Mejia		TIME VISIT/ INSPECTION COMPLETED:	01:45 PM

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On 02/28/2025 Licensing Program Analyst (LPA) Pa Kou Vue conducted an unannounced Annual Required Inspection for the preschool license. LPA met with Director Maria Mejia and toured the facility indoors and outdoors.

This facility operates an AM and PM session Monday through Friday on a traditional school year schedule. AM session is 8:00 – 11:00, PM session is 11:50 – 2:50. PST verified facility phone number is (209) 385-6378.

Facility representative stated there are no poisons stored on the premises.

Facility representative stated there are no firearms or ammunition allowed or stored on the premises.

Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible.

There is no swimming pool or other bodies of water 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. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. 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 personal water bottles and drinking fountains This facility does provide meals to children, snacks are provided. Food is prepared on site. Menus are posted at least one week in advance where an authorized representative can view them.

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SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Pa Kou Vue
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025

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 02/28/2025 01:21 PM - It Cannot Be Edited

Created By: Pa Kou Vue On 02/28/2025 at 12:36 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: ADA GIVENS PRESCHOOL	FACILITY NUMBER: 240407459
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/28/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

101700(b)

Written Directives for Lead Testing

(b) All licensed Child Care Centers operating in buildings constructed before January 1, 2010, shall test their water for lead pursuant to these written directives. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observations, staff iinterviews and records review, the licensee did not comply with the section cited above in that Outlet C Kitchen Sink located in the cafeteria is at ALE of 7.1 ppb. which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/07/2025
	Plan of Correction
1 2 3 4	Outlet C Kitchen Sink was made off-limits and closed off on 02/28/2025. Facility representative stated Outlet C Kitchen Sink will be scheduled for another retesting to meet ALE requirements. Copies of a new work order and schedule date will be sent to LPA via email by end of business day 03/07/2025.

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:

Pa Kou Vue

LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025

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: ADA GIVENS PRESCHOOL	FACILITY NUMBER: 240407459
	VISIT DATE: 02/28/2025

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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 childcare 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 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 Childcare 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 Childcare 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 childcare 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.

Upon LPA observations, staff interviews and records review indicate that Outlet C Kitchen Sink located in the cafeteria is at ALE of 7.1 ppb. Outlet C Kitchen Sink was made off-limits and closed off on 02/28/2025. Outlet C Kitchen Sink will be scheduled for another retesting to meet ALE requirements.

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SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Pa Kou Vue
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025

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: ADA GIVENS PRESCHOOL	FACILITY NUMBER: 240407459
	VISIT DATE: 02/28/2025

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LPA discussed safe sleep regulations with facility representative and discussed the Childcare 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.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. 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 Childcare Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare 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 Facility Representative – Director Maria Mejia. 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).

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: Pa Kou Vue
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025

LIC809 (FAS) - (06/04)

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