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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243808724
Report Date: 12/22/2021
Date Signed: 12/22/2021 11:39:50 AM

Document Has Been Signed on 12/22/2021 11:39 AM - 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:BUHACH PRESCHOOLFACILITY NUMBER:
243808724
ADMINISTRATOR:GAMA, JUANFACILITY TYPE:
850
ADDRESS:2606 N. BUHACH ROADTELEPHONE:
(209) 489-2008
CITY:ATWATERSTATE: CAZIP CODE:
95301
CAPACITY: 89TOTAL ENROLLED CHILDREN: 89CENSUS: 61DATE:
12/22/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Roberta Heredia - AdministratorTIME COMPLETED:
12:00 PM
NARRATIVE
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On 12/22/21, Licensing Program Analyst (LPA) Joseph Pacheco conducted an unannounced case management inspection. LPA met with Administrator, Roberta Heredia to discuss Community Care Licensing (CCL) regulations. Director, Juan Gama was available by phone. LPA discussed the purpose of the inspection with Administrator and obtained a census. During inspection of the facility on 10/18/21 and 11/10/21 LPA observed a child using the restroom without visual supervision of staff.

Per California Code of Regulations, Title 22, Division 12, Chapter 1 the following deficiency is found (See LIC9099-D): Upon receipt of a Type A violation, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. A copy of LIC 9224 was given to Director.

LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.
SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Joseph Pacheco
LICENSING EVALUATOR SIGNATURE: DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/22/2021
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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Document Has Been Signed on 12/22/2021 11:39 AM - It Cannot Be Edited


Created By: Joseph Pacheco On 12/22/2021 at 08:26 AM
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: BUHACH PRESCHOOL
FACILITY NUMBER: 243808724

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/22/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/23/2021
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision; No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement was not met as evidenced by: LPA observation on 10/18/21
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Facility has selected to be referred to the Technical Support Program. Director was reminded of Non Compliance Conference on 1/25/21 at which time Director was advised that there is possible administrative action if facility does not comply with Title 22 regulations.
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and 11/10/21 of a child using the restroom unattended. This is an immediate risk to the health, safety or personal rights of children in care. Because this is a repeat violation within a 12 month period a civil penalty is being issued.
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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:Diana deLeon
LICENSING EVALUATOR NAME:Joseph Pacheco
LICENSING EVALUATOR SIGNATURE:
DATE: 12/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/22/2021


LIC809 (FAS) - (06/04)
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