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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243808263
Report Date: 11/01/2023
Date Signed: 11/01/2023 01:54:29 PM

Document Has Been Signed on 11/01/2023 01:54 PM - 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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:ELIM HEAD STARTFACILITY NUMBER:
243808263
ADMINISTRATOR:NICOLE CABACUNGANFACILITY TYPE:
850
ADDRESS:7677 LANDER AVENUETELEPHONE:
(209) 381-5170
CITY:HILMARSTATE: CAZIP CODE:
95324
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 0DATE:
11/01/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Nicole CabacunganTIME COMPLETED:
02:15 PM
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On 11/01/2023 Licensing Program Analyst (LPA) Pa Kou Vue conducted an unannounced Annual Required Inspection for the preschool license. LPA met with Director Nicole Cabacungan and toured the facility indoors and outdoors and a census was taken. On the day of the unannounced inspection, no children were in care due to teacher work day.

The facility is opened from August to June with an AM and PM program. AM programs days and hours of operation are Monday to Friday, 8:00AM-11:30AM. PM programs days and hours of operation are Monday to Friday, 1:00PM-4:30PM.

No poisons were observed during the inspection. Facility representative stated there are no poisons kept on the premise. LPA observed disinfectants and cleaning solutions stored in the upper cabinets located in both restrooms and above the sinks located in the back of the room. Cabinets are made inaccessible to children in care with the use of safety latches. Medication and other hazardous items are made inaccessible.

Facility representative stated there are no firearms or ammunition allowed or stored on the premises.

Facility representative stated there is no swimming pool or other bodies of water on the premises.

Furniture and equipment are in good condition, free of sharp, lose or pointed parts. LPA observed balance beam located in the outdoor play area broken with sharp broken pieces sticking out in multiple areas of the beam. Director stated she put in a work order the beginning of the school year and is awaiting for a response. Copies of the work order and email communication was provided to LPA. Areas around high climbing equipment, swings and slides have cushioning material to absorb falls.

All toilets and handwashing facilities are in safe and sanitary operating condition. The facility has one or more functioning carbon monoxide detectors. Floors in the facility are clean and safe. LPA observed a solid waste storage container located in the classroom with an open lid. Director stated she will replace open lid with a closed and tight fitted lid to meet regulations.

(Continued in 809-C)

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Pa Kou Vue
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2023
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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: ELIM HEAD START
FACILITY NUMBER: 243808263
VISIT DATE: 11/01/2023
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Drinking water is available both indoors and outdoors. Drinking water is provided by drinking fountains and water dispenser and disposable cups. This facility does provide meals to children, snacks are provided. Food is off center premises. Menus are posted at least one week in advance where an authorized representative can view them.

Capacity and limitations as specified on the license are being maintained. At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at offsite activities. The name of the childcare center director or fully qualified teacher(s) designated to act in the director’s absence has been reported to the Department. All children are under supervision, including visual supervision, of a teacher at all times. Facility meets teacher-child ratios.

LPA reviewed a sample of children’s files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child and medical assessment. LPA reviewed a sample of staff files and observed files were complete with health screening, immunization records for influenza, pertussis and measles and current documentation of completed mandated reporter training.

LPA 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).

Facility representative 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.

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.

(Continued on 809-C)

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Pa Kou Vue
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023
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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: ELIM HEAD START
FACILITY NUMBER: 243808263
VISIT DATE: 11/01/2023
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LPA discussed safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource.

LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. 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-carecenters/.

Facility representative 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 facility representative. Appeal rights were provided.

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

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.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Pa Kou Vue
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023
LIC809 (FAS) - (06/04)
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