Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503604250
Report Date: 11/20/2018
Date Signed 11/20/2018 12:58:37 PM

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:ALBERTA MARTONE PREFORMAL CENTERFACILITY NUMBER:
503604250
ADMINISTRATOR:SIEGEL, ANNFACILITY TYPE:
850
ADDRESS:1413 POUST ROADTELEPHONE:
(209) 576-4077
CITY:MODESTOSTATE: CAZIP CODE:
95351
CAPACITY:24CENSUS: 23DATE:
11/20/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Kimbra DraperTIME COMPLETED:
01:10 PM
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An unannounced Annual/Random inspection conducted by LPA Alice Juarez. Met with Coordinator of Curriculum, Kimbra Draper. 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. No firearms and poisons are inaccessible to children. Disinfectants, hazardous items and medications are inaccessible to children. No medication is being given at this time. Carbon monoxide is installed and working order. Furniture and equipment are sufficient and age appropriate. The playground equipment and outdoor activity space is maintained and in good condition. Food preparation area is clean, food is protected from contamination. The facility is in compliance with conditions and limitations specified on the license. Teacher/child ratios are maintained and adequate supervision is being provided during this visit. No excluded individuals are present. Staff subject to a criminal record clearance or exemption are associated to the facility. First aid/CPR reviewed and in compliance. Fire/disaster drill conducted every six months. Sign in/sign out sheets were reviewed. Children and staff files reviewed. Staff current on the immunization's. The child care center hours/days of operation are: Monday through Friday, 7:00 to 5:30 p.m. This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records.
Site Visit Notice posted on the parent board. Exit interview was conducted.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Alice JuarezTELEPHONE: (559) 341-5280
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2018
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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