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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 540403104
Report Date: 12/01/2021
Date Signed: 12/01/2021 12:40:38 PM

Document Has Been Signed on 12/01/2021 12:40 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:ST. CLEMENT'S DAY CARE CENTERFACILITY NUMBER:
540403104
ADMINISTRATOR:CRAWFORD, S.FACILITY TYPE:
850
ADDRESS:498 NORTH VALENCIA BLVD.TELEPHONE:
(559) 564-8668
CITY:WOODLAKESTATE: CAZIP CODE:
93286
CAPACITY: 31TOTAL ENROLLED CHILDREN: 31CENSUS: 0DATE:
12/01/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Director, Ruth PowersTIME COMPLETED:
01:00 PM
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On 12/1/2021, Licensing Program Analyst (LPA) Jose Penate, conducted an unannounced Required Annual inspection. LPA met with Director, Ruth Powers and toured the facility, both indoors and outdoors. This facility runs year around, 7:30AM to 5:30PM Monday thru Friday.

Disinfectants, cleaning solutions and other dangerous items shall be inaccessible to children. No poisons were observed during today’s visit. All materials and surfaces accessible to children are toxic free.

Solid waste storage vessels, including moveable bins, have tight-fitting covers on, are in good repair. Uncontaminated drinking water is available both indoors and outdoors. All foods/beverages capable of rapid spoiling are stored in covered containers at 45 (F) or less. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. Playground equipment is in good condition, free of sharp, loose, or pointed parts.

Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Playground equipment is in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All toilets and handwashing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe. 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.

Continued on LIC 809-C
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Jose Penate
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2021
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: ST. CLEMENT'S DAY CARE CENTER
FACILITY NUMBER: 540403104
VISIT DATE: 12/01/2021
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CCL shall notify a licensee to immediately terminate the employment of, or to remove/bar any person with specified convictions or for other reasons. The licensee shall comply with the notice. Before working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have a clearance or exemption and have been associated to the facility. Staff records contain appropriate, documentation of education credits. The person, who signs the child in/out, is responsible for the child, uses their full legal signature and records the time of day. Child's admission agreement is available for review.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations no deficiencies are observed today.

Exit interview was conducted with Director, Ruth Powers.

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



LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Jose Penate
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2021
LIC809 (FAS) - (06/04)
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