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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503605506
Report Date: 09/22/2023
Date Signed: 09/22/2023 03:53:07 PM

Document Has Been Signed on 09/22/2023 03:53 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:CHATOM STATE PRESCHOOLFACILITY NUMBER:
503605506
ADMINISTRATOR:NUNES, SANDRAFACILITY TYPE:
850
ADDRESS:7221 CLAYTON ROADTELEPHONE:
(209) 664-8003
CITY:TURLOCKSTATE: CAZIP CODE:
95380
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 13DATE:
09/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Sandra NunesTIME COMPLETED:
04:00 PM
NARRATIVE
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On 09/22/2023 Licensing Program Analyst (LPA) Pa Kou Vue, conducted an unannounced Annual Required Inspection for the preschool license. LPA met with Director Sandra Nunes and toured the facility indoors and outdoors and a census was taken. License has a AM and PM preschool program. Days and hours of operation are Monday to Friday, 8:00AM-11:00AM and 11:45AM-2:45PM and is open from August to May.

No poisons were observed during the inspection. Director Sandra Nunes stated there are no poisons kept on site. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. LPA observed disinfectants and cleaning solutions in children’s restroom and made inaccessible due to height of storage. LPA observed disinfectants and cleaning solutions in kitchen which is stored above the staff refrigerator and underneath the kitchen sink which is made inaccessible with the use of a latch.

There is no swimming pool on the premise. LPA observed other bodies of water on the premises. LPA observed multiple play equipment’s (plastic storage bin, play sink and large plastic tub) located in accessible play area with water and soap.

Director Sandra Nunes stated 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. 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. The 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.

(Continued on 809-C)

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Pa Kou Vue
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2023
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 09/22/2023 03:53 PM - It Cannot Be Edited


Created By: Pa Kou Vue On 09/22/2023 at 02:49 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: CHATOM STATE PRESCHOOL
FACILITY NUMBER: 503605506

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/22/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101238.5(a)(1)
Wading Pools
(a) Notwithstanding the requirements of Section 101238(e), fencing is not required for inflatable or other portable plastic wading pools with sides low enough for children using the pool(s) to step out unassisted. (1)These pools shall be emptied after each use.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, LPA observed multiple play equipment’s (plastic storage bin, play sink and large plastic tub) located in accessible play area with water and soap. The licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/23/2023
Plan of Correction
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Director Sandra Nunes immediately disposed of containers with water and soap. Facility will conduct staff training regarding bodies of waters requirements via the CDSS website and submit a sign-in and sign-out sheet with staff member's printed names, signaturs and date to LPA via email.
Type A
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on Staff Records Review, S1, S2, S3, S4 and S5's Mandated Reporter Certifications were expired or missing. The licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/23/2023
Plan of Correction
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Mandated Reporter training was conducted on 08/10/2023. Licensee is to submit copies of Mandated Reporter Certifications for the staff members via email to LPA.
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: 09/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/22/2023


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Document Has Been Signed on 09/22/2023 03:53 PM - It Cannot Be Edited


Created By: Pa Kou Vue On 09/22/2023 at 02:49 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: CHATOM STATE PRESCHOOL
FACILITY NUMBER: 503605506

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/22/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview with Director Sandra Nunes, the facility's water lead testing was completed in 12/2022. LPA conducted a records review and the following forms were not submitted to Child Care Licensing; LIC9275, LIC9276 and LIC999. Copies of the results were provided to LPA. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/29/2023
Plan of Correction
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Submit completion of LIC9275, LIC9276 and LIC999 to Child Care Licensing and follow procedures to properly submit LIC forms to the link(s) provided on LIC forms to ensure complete submition of required forms. Until further notice, water fountains located inside the facility and outdoor in the play area is to be closed off and made inaccessible to children.
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, LPA observed garden tools (a rake, brooms and loose water hose), broken/unused plastic play structure, bricks and exposed pipe in an accessible outdoor area next to play area. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/29/2023
Plan of Correction
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Remove items in accessible area by proper storage or disposal. In addition, properly cover exposed pipes for safety. Submit picture proof to LPA via email.
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: 09/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/22/2023


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Document Has Been Signed on 09/22/2023 03:53 PM - It Cannot Be Edited


Created By: Pa Kou Vue On 09/22/2023 at 02:49 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: CHATOM STATE PRESCHOOL
FACILITY NUMBER: 503605506

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/22/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101217(a)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on Staff Records Review, Staff 4 and Staff 5 are missing personnel records from file (LIC503, LIC9108 and LIC9052). The licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/29/2023
Plan of Correction
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Licensee is to have staffs complete forms. Submit "original" LIC503, LIC9108 and LIC9052 to Child Care Licensing by mail.
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:Juvenal Moctezuma
LICENSING EVALUATOR NAME:Pa Kou Vue
LICENSING EVALUATOR SIGNATURE:
DATE: 09/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/22/2023


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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: CHATOM STATE PRESCHOOL
FACILITY NUMBER: 503605506
VISIT DATE: 09/22/2023
NARRATIVE
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Drinking water is available both indoors and outdoors. Drinking water is provided by drinking fountains which is in accessible outdoor play area and inside the preschool classroom. Based on interview with Director Sandra Nunes, the facility's water lead testing was completed in 12/2022. LPA conducted a records review, and the following forms were not submitted to Child Care Licensing; LIC9275, LIC9276 and LIC999. Copies of the results were provided to LPA.

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.

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 not complete with health screening, immunization records for influenza, pertussis and measles and current documentation of completed mandated reporter training. Based on Staff Records Review, Staff 4 and Staff 5 are missing personnel records from file (LIC503, LIC9108 and LIC9052).In addition, based on Staff Records Review, S1, S2, S3, S4 and S5's Mandated Reporter Certifications were expired or missing.

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).

Director Sandra Nunes 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.

(Continued on 809-C)

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Pa Kou Vue
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023
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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: CHATOM STATE PRESCHOOL
FACILITY NUMBER: 503605506
VISIT DATE: 09/22/2023
NARRATIVE
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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 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 Director Sandra Nunes to the Department website for lead: www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information.

LPA discussed safe sleep regulations with Director Sandra Nunes 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 Director Sandra Nunes 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 Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

Director Sandra Nunes 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.

(Continued on 809-C)

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Pa Kou Vue
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023
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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: CHATOM STATE PRESCHOOL
FACILITY NUMBER: 503605506
VISIT DATE: 09/22/2023
NARRATIVE
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Exit interview conducted and report was reviewed with Director Sandra Nunes Appeal rights were provided.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, no deficiencies are cited. Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited: (see next page).

Upon receipt of a Type A violation, the 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 the Fact Sheet - Child Care Parent Notification Requirements and a copy of LIC 9224 Acknowledgement of Receipt of Licensing Reports was given to Director Sandra Nunes

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: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023
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