100405197-10-26-2020-04-CC-KPAO-BURPAV-20201026110919

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 100405197
Report Date: 10/26/2020
Date Signed: 10/26/2020 11:09:22 AM

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:	KIDS KARE RIVER PARK		FACILITY NUMBER:	100405197
ADMINISTRATOR:	CHANNITA, BARBARA		FACILITY TYPE:	840
ADDRESS:	7311 N. FIRST STREET		TELEPHONE:	(559) 431-2566
CITY:	FRESNO	STATE: CA	ZIP CODE:	93710
CAPACITY:	95	CENSUS: 55	DATE:	10/26/2020
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Barbara Channita		TIME COMPLETED:	11:00 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 10/26/2020, Licensing Program Analyst (LPA) Kathy Pacheco and LPA Kari McWilliams conducted an unannounced case management inspection at the facility and met with Administrator, Barbara Channita, to discuss an incident that occurred on 10/12/2020. A complete file review was conducted prior to the inspection. LPAs toured the facility, took a census, interviewed staff and children, and observed area in which the incident occurred. On 10/12/2020 at approximately 3:35 PM., Child #1 (see Confidential Names List form (LIC 811) was playing and running on the soccer field at the facility when she slipped and fell. Child #1 stated another child was chasing her and she slipped on a wet and muddy section of the field. Child #1 stated she fell backwards on her bottom and placed her arms down when she fell backwards. Child #1 said her left arm was hurting and she started crying. She said another child helped her get up and she walked over to where Teacher #1 was sitting. Child #1 said she told Teacher #1 her arm was hurting and Teacher #1 sent her inside. Teacher #1 was not present at the facility during the case management inspection however, Teacher #2 was present and stated she was inside the office when Teacher #1 messaged her on the walkie-talkie to say Child #1 had fallen and was coming inside for some ice. When Child #1 came into the office, Teacher #2 said she got ice for Child #1 and had her sit down in a chair on top of a bag because her bottom was dirty from the fall in the mud. In the meantime, Teacher #2 said she had informed the Assistant Director of Child #1 falling and the Assistant Director contacted Child #1's mother. Teacher #2 said Child #1 was not crying and wasn't complaining of pain. She said she asked Child #1 if she wanted to go back outside and she said yes. Teacher #2 said Child #1 never complained about being in pain while she was at the facility. She said it wasn't until the next day they realized Child #1's mother had taken her to the hospital and she was diagnosed with a hairline fracture to her shoulder. Child #1 did return to the facility the next day with her arm in a sling. (continued on next page)

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Kathy Pacheco	TELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2020

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, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: KIDS KARE RIVER PARK	FACILITY NUMBER: 100405197
	VISIT DATE: 10/26/2020

NARRATIVE

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Based on the information obtained, LPAs determined Licensee handled the incident correctly. After interviewing staff and children and reviewing facility records, LPAs determined Licensee took appropriate measures to address Child #1's injury. LPAs further determined Licensee followed proper policies and procedures and no regulations were violated.

Per California Code of Regulations Title 22, Division 12, no deficiency cited during today's inspection.

Exit interview conducted with Administrator. LPAs provided Administrator with a Technical Assistance (LIC 9102) regarding the reporting of all reportable incidents within the next working business day. A copy of this report, the LIC 9102, the LIC 811, and the Notice of Site Visit (LIC 9213) were provided to the facility. The LIC 9213 is required to be posted for 30 days.

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Kathy Pacheco	TELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2020

LIC809 (FAS) - (06/04)

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