Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503604250
Report Date: 05/10/2016
Date Signed 05/10/2016 03:22:47 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:ALBERTA MARTONE PREFORMAL CENTERFACILITY NUMBER:
503604250
ADMINISTRATOR:MICHELLE BOELTERFACILITY TYPE:
850
ADDRESS:1413 POUST ROADTELEPHONE:
(209) 576-4077
CITY:MODESTOSTATE: CAZIP CODE:
95351
CAPACITY:24CENSUS: 22DATE:
05/10/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Teacher, Maryann Carisoza TIME COMPLETED:
03:15 PM
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(2) An unannounced annual/random visit is made today. Met with Teacher, Maryann Carisoza. . LPA explained the Incidental Medical Services (IMS) for the Child Care Center requirements. LPA thoroughly explained the processes and procedures. LPA explained that this procedure must be submitted within the next 30 days, the licensee must submit proof of compliance with the plan of operation as per Title 22, Division 12, Chapter 1 regulations and 101173(c). A tour of facility was conducted inside and outside. Staff and children were spoken to during visit. The following areas are in compliance during this visit: There are no bodies of water. Fire arms and ammunition are not on the premises. Disinfectants, hazardous items and medications are inaccessible to children. Storage area for poisons is locked. Furniture and equipment are sufficient, age appropriate and in good repair. The playground equipment and outdoor activity space is maintained and in good condition with adequate cushioning material. Children's toilets, hand washing facilities are sanitary. There are two classrooms. Rooms are safe and clean. Food preparation area is clean, food and beverages are stored in covered containers at 45 degrees F or less if required, and storage containers for solid waste are covered. Drinking water is available both indoors and outside. Measures are taken to keep facility free of insects and rodents. Staff subject to a criminal record clearance or exemption are associated to the facility. Teacher/child ratios are maintained and adequate supervision is being provided during this visit. No excluded individuals are present. First Aid/CPR reviewed and in compliance. Sign in/sign out sheets maintained. Emergency information forms reviewed for some children. Staff records contain documentation of education, training, and/or experience. Menus are posted.

No deficiencies observed in the areas inspected during today's visit.

A COPY OF THIS REPORT MUST REMAIN IN THE FACILITY FOR PUBLIC REVIEW
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 243-8104
LICENSING EVALUATOR NAME: Alice JuarezTELEPHONE: (559) 341-5280
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2016
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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