Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153808357
Report Date: 04/26/2016
Date Signed: 04/26/2016 10:40:06 AM

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: 35DATE:
04/26/2016
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Jennifer CoburnTIME COMPLETED:
11:00 AM
NARRATIVE
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Licensing Program Analyst (LPA) Brannon met with director, Jennifer Coburn, and administrator, Shelby Rash. Incident took place on 4/4/16, involving child #1, and another child. Child #1 inappropriately touched another child. Documentation shows that child # 1 has hit on different occasions, and has left bruising; slapped a child across the face resulting in a mark. Child #1 has been hit by other children, and scratched. Child #1 has pulled down other children's pants two other times. Child #2 has pulled down their pants to show her bottom to the day care children. Per director, child #1 left facility from 11/25/15 to 3/9/16. Community Care Licensing was only notified of the incident on 4/4/16. The other incidents involving children exposing themselves to other day care children, or pulling down pants of other children; and hitting/slapping that left marks were not reported.

During previous visit, conducted on 4/21/16, LPA observed children in the gym during free play. While observing children and staff, LPA observed several children without visual supervision. There is adequate staffing, however, staff was not in the best positions to provide adequate visual supervision.

Type A deficiency was cited. Upon receipt, 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.

Per California Code of Regulations Title 22, Division 12, these deficiencies are to be cited. Exit interview conducted with administrator, Shelby Rash, and director, Jennifer Coburn. POC/Appeal Rights were given and discussed.

A COPY OF THIS REPORT IS TO REMAIN IN THE FACILITY FOR PUBLIC REVIEW.
THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
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: 04/26/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2016
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3


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: 04/26/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/03/2016
Section Cited
101223(a)(2)
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101212(d)(1)(C) Reporting Requirements. Any unusual incident or child absence that threatens the physical or emotional health or safety of a child shall be reported to the Department within 24 hours of the occurrence. The Department was not notified by licensee of the several reportable incidents that took place.
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Per administrator, Shelby Rash, staff will receive training. Training agenda and copy of staff attendance shall be sent to the Fresno Community Care Licensing office by 5/3/16.
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Director was not aware that these types of incidents were reportable. This is a safety hazard.
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Type B
05/03/2016
Section Cited
101218.1(a)(2A)
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Admission Procedures and Parental and Authorized Representative's Rights. Enables the person responsible for admissions to understand the state of the child's health and physical and emotional development, and to assess whether the child care center can meet the child's needs. There is no documentation
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Per administrator, Shelby Rash, staff will receive training. Training agenda and copy of staff attendance shall be sent to the Fresno Community Care Licensing office by 5/3/16.
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of conference meetings with child #1's parent(s). This is a safety hazard.
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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: 04/26/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2016
LIC809 (FAS) - (06/04)
Page: 2 of 3


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: 04/26/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/03/2016
Section Cited
101223(a)(2)
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Personal Rights. Each child shall be accorded safe, healthful and comfortable accommodations, furnishings and equipment. LPA observed documentation that child #1 hit/slapped other day care children leaving bruising and a mark. Child #1 pulled down the pants of day care children on two separate occasions.
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Per administrator, Shelby Rash, staff will receive training. Training agenda and copy of staff attendance shall be sent to the Fresno Community Care Licensing office by 5/3/16.
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It was reported that child #1 touched another child inappropriately. This is a safety and health hazard.
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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: 04/26/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2016
LIC809 (FAS) - (06/04)
Page: 3 of 3