<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 220407026
Report Date: 11/28/2023
Date Signed: 11/29/2023 08:49:18 AM

Document Has Been Signed on 11/29/2023 08:49 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:MARIPOSA PRESCHOOL, INC.FACILITY NUMBER:
220407026
ADMINISTRATOR:LEE, JACKIFACILITY TYPE:
850
ADDRESS:3415 WOODLAND DRIVETELEPHONE:
(209) 966-2665
CITY:MARIPOSASTATE: CAZIP CODE:
95338
CAPACITY: 20TOTAL ENROLLED CHILDREN: 15CENSUS: 12DATE:
11/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Mary Weaver TIME COMPLETED:
02:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 11/28/23 Licensing Program Analyst (LPA) Denisia Jimenez arrived at facility to conduct an unannounced Annual Required Inspection for the preschool license. LPA met with Teacher, Mary Weaver, and toured the facility indoors and outdoors. This is a parent-cooperative center. The facility operates on a traditional school year schedule with half-day program. Days and hours of operation are Tuesday-Thursday from 8:00 AM – 12:00 PM. The facility consists of 1 preschool classroom. LPA confirmed facility has a working telephone number of 209-966-2665. LPA observed 12 children in the classroom with 1 teacher and 2 Volunteers. Facility was operating within their ratio requirements. LPA observed all required postings.

LPA observed the playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. Shade is provided by 5 mature trees all around the playground. The Teacher stated that there are no bodies of water present in the facility, LPA did not observe any bodies of water. Furniture and equipment were inspected for good repair, free of sharp, loose, or pointed parts and all equipment appeared fine during the inspection. The Teacher stated that there are no weapons on the premises. The toilets and hand washing facilities are in safe and sanitary operating conditions.
Preschool children are provided with AM snack only. Each parent is required to volunteer once a month and bring a healthy snack. All kitchen, food preparation, and storage areas are clean, free of litter, rubbish, and rodents/vermin. All food is protected from contamination. Children are provided with drinking water and children are required to bring their own water bottle. If a child forgets to bring a water, then the facility provides them a water bottle. All storage containers for solid waste, including moveable bins, have tight fitting covers on and are in good repair. Facility has functioning smoke detector/carbon monoxide detector and a complete first aid kit.

(Continued on 809-C)
SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Denisia Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2023
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 4
Document Has Been Signed on 11/29/2023 08:49 AM - It Cannot Be Edited


Created By: Denisia Jimenez On 11/28/2023 at 01:19 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: MARIPOSA PRESCHOOL, INC.
FACILITY NUMBER: 220407026

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/28/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101221(b)(8)(C)
Child's Records
(C) A signed consent form for emergency medical treatment unless the child's authorized
representative has signed the statement specified in Section 101220(f).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above. Upon reviewing files LPA observed 3 out of 5 children's file did not have the form. LPA explained to the teacher the importance of having all the forms in the children's files which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/12/2023
Plan of Correction
1
2
3
4
The teacher stated that all children's file will be reviewed to make sure all the forms are in the file. The teacher stated that she will letter to LPA by 12/12/23 explaining the importance of getting all children's forms in the files.
Type B
Section Cited
CCR
101223(b)(1)
Personal Rights
(1) The center shall give each authorized representative a copy of the Personal Rights form (LIC 613A [9/96]).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above. Upon reviewing files LPA observed 3 out of 5 children's file did not have the form. LPA explained to the teacher the importance of having all the forms in the children's files which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/12/2023
Plan of Correction
1
2
3
4
The teacher stated that all children's file will be reviewed to make sure all the forms are in the file. The teacher stated that she will letter to LPA by 12/12/23 explaining the importance of getting all children's forms in the files.
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:Juvenal Moctezuma
LICENSING EVALUATOR NAME:Denisia Jimenez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/28/2023


LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: MARIPOSA PRESCHOOL, INC.
FACILITY NUMBER: 220407026
VISIT DATE: 11/28/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. LPA reviewed 5 children’s files. Children’s Records were reviewed for completeness and inspection of required forms was not made. 3 out of 5 children’s file did not contain Consent for Emergency Medical Treatment and Personal Rights. LPA explained the importance of all required forms in the children’s files. LPA will cite two Type B citations. LPA reviewed 3 staff files. Only one staff file contained the required transcripts/verification of experience/immunization records, and Health Screening Report. The other 2 staff are volunteers and will get the required immunization records, and Health Screening Report. One staff has a current Mandated Reporter Training certificate. The volunteers are in the process of doing the Mandated Reporter Training. At least one staff has a current CPR and First Aid certification. The Teacher understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips).
The teacher was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

The teacher stated the facility does administer medication to children. Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). LPA verified that the lead testing was completed in accordance with the Written Directives outlined in PIN 21-21.1-CCP. LPA referred the Director to the Department website for lead: www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information. The Teacher stated the lead testing was done through the county. The county maintains the building. The Teacher is awaiting results and will provide documentation to the LPA when received.

(Continued on 809-C)

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Denisia Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: MARIPOSA PRESCHOOL, INC.
FACILITY NUMBER: 220407026
VISIT DATE: 11/28/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA and the Teacher discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to resources such as forms, regulations Provider Information Notices (PINs), and Quarterly Updates.

LPA discussed Reporting Requirements as outlined in the regulations (Section 101212).

The Teacher was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Exit interview conducted and report was reviewed with Teacher, Mary Weaver. Appeal rights were provided.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiencies are being cited: (see next 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: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Denisia Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4