Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 163808877
Report Date: 04/20/2015 12:00:00 AM
Date Signed 04/20/2015 12:34:01 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 E.SHAW AV,STE 300-MS 29-01
FRESNO, CA 93710
FACILITY NAME:BUILDING BLOCKS TO LEARNING CHILDCAREFACILITY NUMBER:
163808877
ADMINISTRATOR:PUGA, VERONICAFACILITY TYPE:
850
ADDRESS:10769 14TH AVE.TELEPHONE:
(559) 772-8400
CITY:ARMONASTATE: CAZIP CODE:
93202
CAPACITY:16CENSUS: 10DATE:
04/20/2015
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Veronica Puga, Stacey GaytanTIME COMPLETED:
12:43 PM
NARRATIVE
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4/7/15 LPA Mike Bussey attempted a Case Management Visit today. Center closed today and on 4/9/15 for SCE project. Notice left on the center front door.
LPA Mike Bussey arrived at the Building Blocks To Learning Childcare today. Met by the Licensee Veronica Puga. Also, present were ten children, the Site supervisor Stacey Gaytan and another teacher. Purpose of visit was to followup on the child care center since there was a new director. Director has clearance and qualifications. Also, reviewed three children's files. SCE completed their project and center did reopen.

See next page regarding deficiency.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 243-8104
LICENSING EVALUATOR NAME: Mike BusseyTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2015
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, 770 E.SHAW AV,STE 300-MS 29-01
FRESNO, CA 93710
FACILITY NAME: BUILDING BLOCKS TO LEARNING CHILDCARE
FACILITY NUMBER: 163808877
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/20/2015
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/04/2015
Section Cited
101221
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101221(b)(8)(C) Child’s Records. A signed consent form for emergency medical treatment shall be in the child’s record unless §101220(f) is applicable. Child#1, #2,and #3 did not have medical consent form(LIC627) in their files.
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Licensee agrees to ensure that medical consent forms(LIC627) are signed by the parents and copies are sent into the Fresno Regional Child Care Office no later than 5/4/15.
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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: Diana deLeonTELEPHONE: (559) 243-8104
LICENSING EVALUATOR NAME: Mike BusseyTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2015
LIC809 (FAS) - (06/04)
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