Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 500319202
Report Date: 03/20/2019
Date Signed: 03/20/2019 01:10:42 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:HUGHSON ELEMENTARY SCHOOLFACILITY NUMBER:
500319202
ADMINISTRATOR:ERIC PETERSENFACILITY TYPE:
850
ADDRESS:7201 E. WHITMORE AVENUETELEPHONE:
(209) 883-4412
CITY:HUGHSONSTATE: CAZIP CODE:
95326
CAPACITY:24CENSUS: 23DATE:
03/20/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Brenda HenleyTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA), Robert Gutierrez, conducted an unannounced annual/random inspection today. LPA met with Site Supervisor, Brenda Henley. LPA toured the facility inside and outside, and census was taken. Staff and children were spoken to during today’s inspection. The following areas are in compliance during this inspection: There are no bodies of water at this facility. Firearms and ammunition are not permitted on the premises. Disinfectants, hazardous items are inaccessible to children. No poisons were observed during todays inspection. Furniture and equipment are sufficient, age appropriate and in good repair. The playground equipment and outdoor activity space is maintained and in good condition with adequate cushioning material. Children's toilets, hand washing facilities are sanitary. Rooms are safe and clean. Drinking water is available both indoors and outside. Measures are taken to keep facility free of insects and rodents. Staff are fingerprinted through the school district as a form of employment. Teacher-child ratios are maintained and adequate supervision is being provided during this inspection. First Aid/CPR certifications were reviewed and are in compliance with regulations. Sign in/sign out sheets are maintained. The facility is in compliance with the conditions, limitations and capacity specified on the license. A sample of children’s files were reviewed and emergency information forms and medical assessment forms were noted. Staff files were reviewed and health screening forms are on file. Menus are posted. This is an AM/PM half day program which operates on a traditional school year schedule. The morning session is 8:00am to 11:00am and the afternoon session is 11:30am to 2:30pm, Monday through Friday.

Continued on 809-C
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Robert GutierrezTELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2019
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: HUGHSON ELEMENTARY SCHOOL
FACILITY NUMBER: 500319202
VISIT DATE: 03/20/2019
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Per Chapter 1, Division 12, Title 22 of the California Code of Regulations no deficiencies are observed today. Site Inspection Notice posted on the parent board. Exit interview was conducted with Site Supervisor, Brenda Henley.

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.

LIC 9213 NOTICE OF SITE INSPECTION FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Robert GutierrezTELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2019
LIC809 (FAS) - (06/04)
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