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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543808961
Report Date: 07/25/2023
Date Signed: 07/25/2023 03:47:40 PM

Document Has Been Signed on 07/25/2023 03:47 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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:GRANDMA'S HOUSE PRESCHOOLFACILITY NUMBER:
543808961
ADMINISTRATOR:JOHNSON, FLORAFACILITY TYPE:
850
ADDRESS:226 S BLACKSTONETELEPHONE:
(559) 687-0925
CITY:TULARESTATE: CAZIP CODE:
93274
CAPACITY: 25TOTAL ENROLLED CHILDREN: 25CENSUS: 10DATE:
07/25/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Flora JohnsonTIME COMPLETED:
04:15 PM
NARRATIVE
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On 07/25/2023 Licensing Program Analysts (LPAs) Paul Garcia and Nancy Her, conducted an unannounced Case Management Inspection for the preschool license. LPAs met with Director, Flora Johnson, and a census was taken.

During today’s inspection, there was an adult who stated she was a staff member providing care and supervision to children in care. This adult does not have a criminal record clearance or an exemption from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiencies are being cited: (see next page, 809 D)

LPA Paul Garcia informed facility representative Flora Johnson that this report dated 07/25/2023 documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Paul Garcia informed the facility representative to provide a copy of this licensing report dated 07/25/2023 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview was conducted and a report was reviewed with the facility representative Flora Johnson.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Paul Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2023
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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Document Has Been Signed on 07/25/2023 03:47 PM - It Cannot Be Edited


Created By: Paul Garcia On 07/25/2023 at 02:20 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: GRANDMA'S HOUSE PRESCHOOL
FACILITY NUMBER: 543808961

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/25/2023
Section Cited
HSC
1596.871(c)(1)(A)

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Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision (f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
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During today's inspection, uncleared staff member left the facility. Facility Representative understands that a criminal record clearance needs to be granted prior to employment.
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Based on observation and record review, the licensee did not comply with the section cited above. There was one staff member providing care and supervision of children that do not have a criminal record clearance or an exemption from the State Department of Social Services prior to employment, residence, or initial presence in the facility which poses an immediate health, safety or personal rights risk to persons in care.
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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:Duane Matsubara
LICENSING EVALUATOR NAME:Paul Garcia
LICENSING EVALUATOR SIGNATURE:
DATE: 07/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/25/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/25/2023 03:47 PM - It Cannot Be Edited


Created By: Paul Garcia On 07/25/2023 at 02:31 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: GRANDMA'S HOUSE PRESCHOOL
FACILITY NUMBER: 543808961

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/28/2023
Section Cited
CCR
102384(a)(e)

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Licensing Fees: An applicant or licensee shall be charged fees as specified in Health and Safety Code Section 1596.803. After initial licensure, a fee shall be charged by the department annually, on each anniversary of the effective date of the license.

This requirement is not met as evidenced by:
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Licensee was advised that she is past due on payment of licensing fees. Licensee will send a copy of the online receipt showing payment or a copy of the check that was sent to the department for payment. A copy of the receipt shall be sent to the Fresno CCL by 07/28/2023.
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Based on record review, the licensee did not comply with the section cited above. Licensee currently owes a total of $363.00 in annual and late fees which poses a potential health, safety or personal rights risk to persons in care.
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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:Duane Matsubara
LICENSING EVALUATOR NAME:Paul Garcia
LICENSING EVALUATOR SIGNATURE:
DATE: 07/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/25/2023


LIC809 (FAS) - (06/04)
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