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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503808581
Report Date: 09/14/2021
Date Signed: 09/14/2021 04:45:05 PM

Document Has Been Signed on 09/14/2021 04:45 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:SYLVAN HEAD STARTFACILITY NUMBER:
503808581
ADMINISTRATOR:HOTCHKISS, JEWELEEFACILITY TYPE:
850
ADDRESS:2908 COFFEE ROADTELEPHONE:
(209) 238-6302
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY: 53TOTAL ENROLLED CHILDREN: 0CENSUS: 12DATE:
09/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Mary Silviera, Master TeacherTIME COMPLETED:
05:00 PM
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On 09/14/2021, Licensing Program Analysts (LPAs) Stefanie Galvan and Luisa Gavoutian, conducted an unannounced Annual Inspection. LPAs met with Master Teacher/Facility Representative, Mary Silviera. LPAs toured the facility, indoors and outdoors. This is an AM extended day program which operates on a traditional school year schedule from 7:30am to 2:30 pm Monday through Friday.

All children are under supervision, including visual supervision, of a teacher at all times. There is a ratio of one teacher supervising no more than 12 children in attendance. 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. Disinfectants, cleaning solutions, medication, and other hazardous items are made inaccessible. No poisons were observed during the inspection. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. All toilets and hand washing facilities are in safe and sanitary operating condition. All floors are clean and safe. The facility is free of flies, insects and rodents. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements.

Meals are provided by the school cafeteria. Snacks and special menu items are prepared by staff in the in-house kitchen. All kitchen, food preparation, and storage areas are clean, free of litter/rubbish and rodents/vermin. All food is protected against contamination and any contaminated food is discarded immediately. Solid waste storage containers have tight-fitting covers and are in good repair. Uncontaminated drinking water is available both indoors and outdoors. Menus are posted at least one week in advance where an authorized representative can view them.

Continued on 809-C
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Stefanie Galvan
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: SYLVAN HEAD START
FACILITY NUMBER: 503808581
VISIT DATE: 09/14/2021
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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 in the form of rubber ground cover to absorb falls.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Community Care Licensing (CCL) shall notify a Licensee to immediately terminate the employment of, or to remove/bar any person with specified convictions or for other reasons; the Licensee shall comply with the notice. Capacity and limitations as specified on the license are being maintained. At least one person trained in Pediatric CPR and 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.



The person who signs the child in/out of the facility uses their full legal signature and records the time of day. LPAs reviewed a sample of children’s files and observed files were complete with contact information for authorized representatives or others who can assume responsibility if the authorized representative cannot be reached. LPAs observed that all children’s files contained a medical assessment. LPAs reviewed a sample of staff files and observed five of seven files reviewed did not have immunization verification for pertussis and four of the seven did not have measles verifications. Six of seven files did not show proof of current Mandated Reporter Training being completed. All seven files did not contain a health screening.

This facility provides Incidental Medical Services – IMS. LPAs reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

Continued on 809-C
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Stefanie Galvan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: SYLVAN HEAD START
FACILITY NUMBER: 503808581
VISIT DATE: 09/14/2021
NARRATIVE
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LPAs and facility representative discussed the Community Care Licensing website (www.ccld.ca.gov) which provides access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Chapter 1, Division 12, Title 22 of the California Code of Regulations, the following deficiencies were found: (see LIC809-D).

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with facility representative, Mary Silviera.
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Stefanie Galvan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/14/2021 04:45 PM - It Cannot Be Edited


Created By: Stefanie Galvan On 09/14/2021 at 03:59 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: SYLVAN HEAD START
FACILITY NUMBER: 503808581

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/14/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record reviews, the licensee did not comply with the section cited above in 4 out of 7 staff files did not contain record of measles and 5 out of 7 files did not contain record of pertussis which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/28/2021
Plan of Correction
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Facility Representative to submit proof of measles and pertussis vaccinations for staff in question by POC date of 9/28/2021.
Type B
Section Cited
CCR
101216(g)(2)
Personnel Requirements
(2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 7 out of 7 staff files reviewed did not contain proof of LIC 503-Health Screening which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/28/2021
Plan of Correction
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Facility Representative to submit proof of LIC 503 forms to CCL by POC date of 9/28/2021
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:Alice Juarez
LICENSING EVALUATOR NAME:Stefanie Galvan
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2021


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/14/2021 04:45 PM - It Cannot Be Edited


Created By: Stefanie Galvan On 09/14/2021 at 04:02 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: SYLVAN HEAD START
FACILITY NUMBER: 503808581

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/14/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
(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 records review, the licensee did not comply with the section cited above in 6 out of 7 staff records reviewed, Mandated Reporter Training certificates were not current which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/28/2021
Plan of Correction
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Facility Respresentative will submit proof of Mandated Reporter Training certificates for all staff by POC date 9/28/2021
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:Alice Juarez
LICENSING EVALUATOR NAME:Stefanie Galvan
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2021


LIC809 (FAS) - (06/04)
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