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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503810061
Report Date: 08/25/2021
Date Signed: 08/25/2021 03:39:03 PM

Document Has Been Signed on 08/25/2021 03:39 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:MAGNOLIA ACADEMYFACILITY NUMBER:
503810061
ADMINISTRATOR:DAVINI, JAMIFACILITY TYPE:
850
ADDRESS:921 WOODROW AVETELEPHONE:
(209) 527-2250
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY: 96TOTAL ENROLLED CHILDREN: 0CENSUS: 52DATE:
08/25/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Director, Monika MartinTIME COMPLETED:
03:50 PM
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On 08/25/2021 Licensing Program Analysts (LPAs) Stefanie Galvan and Luisa Gavoutian, conducted an unannounced Annual Required Inspection. LPAs met with Director, Monika Martin, and toured the facility indoors and outdoors. Days and hours of operation are Monday through Friday 6:30AM to 6:00PM.

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.

LPAs observed the sink and faucet in the Peaches classroom to have rust and grime. A maintenance order was put in during inspection for repair. Metal playground structures in the large play yard have chipped paint and shall be re-painted. The outdoor boat-shaped planter in the 2's yard is broken, exposing sharp edges and splinters. This structure shall be repaired or removed. LPAs observed the "2's" playground to have a tree trunk that has exposed holes in the ground. These holes are to be filled with dirt/filler. All toilets and handwashing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe. Solid waste storage containers are in good repair. One trash receptacle in the kitchen is missing a lid. This lid has been ordered during the inspection. Drinking water is available both indoors and outdoors. LPA's observed that water cups were not in a proper dispenser. A dispenser was ordered during today's inspection. Areas around high climbing equipment, swings and slides have cushioning material to absorb falls. The facility is free of flies, insects and rodents. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have received a criminal record clearance or exemption. Upon notification from the Department, the licensee will comply and act immediately to terminate the employment of, remove from the facility or bar from entering the facility for any person it is deemed necessary while the Department considers granting or denying an exemption. 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. Continued on LIC 809-C

SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Stefanie Galvan
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2021
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: MAGNOLIA ACADEMY
FACILITY NUMBER: 503810061
VISIT DATE: 08/25/2021
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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. During today's inspection, LPAs reviewed sign-in/out records and found that four children had not been signed out on previous days in the month of August, one child was not signed in on a previous day in August, one child was signed in on the wrong day, but was present at the facility today, and another child was present at the facility today, but had already been signed out. All children are under supervision, including visual supervision, of a teacher at all times. LPAs observed Staff 1 was providing care to 10 children in the "Olives" classroom alone. A review of Staff 1's records showed that Staff 1 does not meet the minimum qualifications of a teacher. Facility maintains a ratio of one teacher supervising no more than 12 children in care. LPAs reviewed a sample of children’s files and observed that two out of ten children's files did not contain a TB risk assessment. Files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child and medical assessment. LPAs reviewed a sample of staff files and observed that one of eight files were incomplete with missing Mandated Reporter Training certificates. Health screening, immunization records for influenza, pertussis and measles and current documentation are being kept. Menus are posted at least one week in advance where an authorized representative can view them. LPAs observed modifications made to the menu and informed Director that modifications should be communicated to authorized representative.

Incidental Medical Services (IMS) are currently being provided. LPAs observed prescription and non-prescription medications for seven children who no longer receive services in this facility. Director was unable to provide LPAs with current IMS plan at this time to verify the procedures for disposal of unused medications. 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.



LPAs and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide 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 Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiencies are to be cited (see 809-D 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: Alice Juarez
LICENSING EVALUATOR NAME: Stefanie Galvan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 08/25/2021 03:39 PM - It Cannot Be Edited


Created By: Stefanie Galvan On 08/25/2021 at 01:40 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: MAGNOLIA ACADEMY
FACILITY NUMBER: 503810061

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/25/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/03/2021
Section Cited
CCR
101216.1(b)(1)(A)

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Teacher Qualifications and Duties (1)A teacher shall have completed... at least six postsecondary semester or equivalent quarter units of the education requirement specified in... (c)(1)This regulation was not met as evidenced by:
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Director stated she shall submit a written statement explaining how non-qualified staff are to be supervised at all times by a fully qualified teacher.
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Based on observation and record review Staff 1 was alone in the classroom and does not meet minimum teacher qualifications. This poses a potential risk to the health, safety, or personal rights of children.
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Type B
09/08/2021
Section Cited
CCR101229.1(a)(1)

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Sign In and Sign Out; The person who signs the child in/out shall use his/her full legal signature and shall record the time of day. This regulation was not met as evidenced by:
Based on record review of sign in/out sheets,
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Director stated she shall ensure that all sign in and sign out binders are checked for accuracy and will submit the plan in writing to CCL by 09/08/2021.
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five children were not signed out on previous days of the month. One child was present today, but signed in on the wrong date. One child was present today, but had been signed out for future time. This poses a potential risk to the health, safety, or personal rights of children.
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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: 08/25/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/25/2021


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/25/2021 03:39 PM - It Cannot Be Edited


Created By: Stefanie Galvan On 08/25/2021 at 02:12 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: MAGNOLIA ACADEMY
FACILITY NUMBER: 503810061

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/25/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/08/2021
Section Cited
CCR
101226(e)(6)

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Health-Related Services-(e)(6) When no longer needed by the child, or when the child withdraws from the center, all medications shall be returned to the child's authorized representative or disposed of after an attempt to reach the authorized representative. This requirement was not met as evidenced by:
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Director agrees to submit a written plan with procedures listed to take to dispose of medications for children who are no longer receiving services.
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Based on LPA observation, seven medications were found to be in the facility which were for children no longer receiving services. This poses a potential risk to the health, safety, or personal rights of children.
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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: 08/25/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/25/2021


LIC809 (FAS) - (06/04)
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