Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503808696
Report Date: 05/27/2015 12:00:00 AM
Date Signed 05/27/2015 12:33:02 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:VIRGINIA PARKS PRESCHOOL PROGRAMFACILITY NUMBER:
503808696
ADMINISTRATOR:FISK, JILLFACILITY TYPE:
850
ADDRESS:1021 MOFFETT ROADTELEPHONE:
(209) 556-1545
CITY:MODESTOSTATE: CAZIP CODE:
95351
CAPACITY:24CENSUS: 24DATE:
05/27/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Julie BohlenderTIME COMPLETED:
12:30 PM
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(1) An unannounced annual/random visit is made today. Met with Teacher, Julie Bohlender. A tour of facility was conducted inside and outside. Hours of operation are from August to May, Monday through Friday from 8:00 AM to 3:30 PM. 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. Rooms are safe and clean. Food preparation area is clean, food is protected from contamination, 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. The facility is in compliance with the conditions, limitations and capacity specified on the license. Emergency information forms and medical assessment forms are reviewed for some children. Health screening forms are reviewed for some staff. 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: 05/27/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2015
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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