Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153808357
Report Date: 12/11/2018
Date Signed: 12/11/2018 12:41:42 PM

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: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:
12/11/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Shelby Rash, Director TIME COMPLETED:
12:50 PM
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Licensing Program Analyst (LPA) Jessika Thompson conducted an unannounced annual/random visit. LPA met with Director, Shelby Rash, who provided a tour of facility, inside and outside, as shown on the facility sketch. There are no bodies of water, firearms and/or ammunition on the premises. Disinfectants, hazardous items and medications are inaccessible to children. Storage area for poisons is locked and inaccessible to children. Furniture, equipment and materials are sufficient, age appropriate, in good repair and toxic free. The playground equipment and outdoor activity space is maintained and in good condition, free of hazards with adequate cushioning material. The facility has a large gymnasium containing bikes and sports equipment for children’s use. Children's toilets and hand washing facilities are sanitary and in good operating condition. Rooms and floors are safe and clean. Facility provides morning snack, lunch and afternoon snack. Storage containers for solid waste are in good repair with tight-fitting covers. Sanitary drinking water is available both indoors and outdoors. The licensee is taking measures to keep the facility free of insects, rodents, etc. No excluded adults are present at the facility. Conditions, limitations and capacity specified on license are in compliance. Staff requiring criminal record clearance or exemptions are associated to the facility as indicated on LIS 555 – Facility Roster. First Aid/CPR reviewed and in compliance. Qualified staff designated to act in the Director’s absence has been reported accordingly. Teacher/child ratios are maintained and adequate supervision is provided during visit. Menus are posted. A sample of children's and staff’s records reviewed. Children’s records include required medical and consent for emergency medical. Staff records contain required documented health screening and immunization records. LPA informed Director Rash of the requirement of Child Abuse Mandated Reporter training for child care providers; a handout was provided. Operating hours are Mon-Fri, 7:00AM – 6:00 PM. (Continued LIC809-C)
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika ThompsonTELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2018
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: HEIR FORCE ACADEMY
FACILITY NUMBER: 153808357
VISIT DATE: 12/11/2018
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department.

Per Chapter 1, Division 12, Title 22 of the California Code of Regulations no deficiencies are observed today.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika ThompsonTELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2018
LIC809 (FAS) - (06/04)
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