Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153808357
Report Date: 04/21/2016
Date Signed: 04/21/2016 01:59:04 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 E.SHAW AV,STE 300-MS 29-01
FRESNO, CA 93710
FACILITY NAME:HEIR FORCE ACADEMYFACILITY NUMBER:
153808357
ADMINISTRATOR:RASH, BILLY J.FACILITY TYPE:
850
ADDRESS:4755 GOSFORD ROADTELEPHONE:
(661) 664-1066
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93313
CAPACITY:75CENSUS: 29DATE:
04/21/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Jennifer CoburnTIME COMPLETED:
02:30 PM
NARRATIVE
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(2)An unannounced annual/random visit is made today. Met with director, Jennifer Coburn. A tour of facility was conducted inside and outside. Staff and children were spoken to during visit. The following areas are in compliance during visit: There are no bodies of water. Firearms and ammunition are not on the premises. Storage area for poisons is locked. Disinfectants, hazardous items and medications are inaccessible to children. Furniture and equipment are sufficient, age appropriate and in good repair. Fire drills are conducted every six months. The playground equipment and outdoor activity space is maintained and in good condition. Children's toilets, hand washing facilities are sanitary. Rooms are safe and clean. Food preparation area is clean, food is protected from contamination, storage containers for solid waste are covered and all food or beverages are stored in covered containers at 45 degrees or less. Drinking water is available both indoors and outside. Menus are posted. The facility is in compliance with conditions and limitations specified on the license. Teacher/child ratios are maintained and adequate supervision is being provided during this visit. Sign in/sign out sheets maintained. No excluded individuals are present. Staff subject to a criminal record clearance or exemption are associated to the facility. First Aid/CPR reviewed and in compliance. Staff records reviewed contain documentation of health screening. Some children’s files were reviewed contain health assessment, and emergency information.
This facility does not provide Incidental Medical Services (IMS) at this time. LPA left a handout for licensee to review.
Per California Code of Regulations Title 22, Division 12, this deficiency to be cited. Exit interview conducted with the director, Jennifer Coburn. The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.
A COPY OF THIS REPORT MUST REMAIN IN THE FACILITY FOR PUBLIC REVIEW.
NOTICE OF SITE VISIT FORM POSTED TO PARENT'S BOARD.

To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISOR'S NAME: Rebecca VarelaTELEPHONE: (559) 243-8106
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2016
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, 770 E.SHAW AV,STE 300-MS 29-01
FRESNO, CA 93710
FACILITY NAME: HEIR FORCE ACADEMY
FACILITY NUMBER: 153808357
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/21/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/05/2016
Section Cited
101238.2(e)
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Outdoor Activity Space. All playground equipment shall be cushioned with material that will absorb a fall. During today's visit, LPA observed a Little Tikes climbing structure. There is a small platform that is an estimated 4'2" off the ground. There was no cushioning under this climbing structure. This is a safety hazard.
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Director, Jennifer Coburn, had the plastic climbing structure removed during visit. Deficiency cleared during today's visit.
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During visit, LPA did not observe any children on the climbing structure. LPA reviewed that cushioning is required to prevent falls that may result in serious injury.
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Type B
05/05/2016
Section Cited
101239.2(a)
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Drinking Water. Uncontaminated drinking water shall be readily available both indoors and out. Licensee is utilizing plastic pitchers for indoor water. However, licensee failed to provide disposable cup dispensers to keep water uncontaminated. This is a health hazard.
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Per Jennifer, cup dispensers will be provided. Licensee shall provide a photographs of cup dispensers being used. Photographs shall be sent to the Fresno Community Care Licensing office no later than 5/5/16.
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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: Rebecca VarelaTELEPHONE: (559) 243-8106
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2016
LIC809 (FAS) - (06/04)
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