100406467-10-12-2021-04-CC-ROCA-C7QSBL-20211012134407

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 100406467
Report Date: 10/12/2021
Date Signed: 10/12/2021 01:44:13 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:	FRESNO CITY COLLEGE CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	100406467
ADMINISTRATOR:	LEWIS D & ANTONIO E		FACILITY TYPE:	850
ADDRESS:	1621 EAST UNIVERSITY AVE		TELEPHONE:	(559) 443-8618
CITY:	FRESNO	STATE: CA	ZIP CODE:	93704
CAPACITY:	82	CENSUS:	DATE:	10/12/2021
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Deborah Lewis and Estefana Antonio		TIME COMPLETED:	02:00 PM

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On 10/12/2021, Licensing Program Analyst (LPA) Ruby Ocegueda, conducted an unannounced case management inspection for the purposes of reviewing an Unusual Incident that was reported to the Department on 9/23/2021. LPA met with Program Coordinators Deborah Lewis and Estefana Antonio, toured the facility indoors and outdoors.

On 9/21/2021 at approximately 3:45 PM, there was a child (child #1) who fell off the monkey bars in the play yard. It was not determined that child#1 had a small fracture on his/her humorous until parent took child #1 to seek medical care on 9/23/2021. At that time, staff contacted Community Care Licensing to report the incident.

Today 10/12/2021, LPA inspected the play yard (specifically where child fell), interviewed staff and reviewed facility records. During todays inspection of the play yard, LPA observed that there was sufficient cushioning material to absorb falls under the monkey bar area and in other areas of the play yard. LPA interviewed Program Coordinator Estefana Antonio who indicated that staff #1 was standing approximately 8-10 feet from the child observing him/her and the others who were utilizing the play structure. Facility records confirmed that staff #1 was supervising 5 children on 9/21/2021. The play structure is labeled for use of children ages 2-12 years old.

LPA Ocegueda recommended that staff assess children's physical ability as best as possible to be able to determine if they are properly able to use the monkey bars on their own or if they might need assistance with this activity. During a file review of child#1's records, there were no physical limitations noted by his/her physician or parent. Child #1 returned to care on 9/23/2021. There were no specific play restrictions by child #1's medical provider, however staff are monitoring child closely during play to ensure he/she does not re-injure or aggravate his/her injury.

Report continued to 809-C

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ruby Ocegueda	TELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

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: FRESNO CITY COLLEGE CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 100406467
	VISIT DATE: 10/12/2021

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Today, LPA determined that facility met all reporting requirements as specified in Title 22 Regulation 101212 - Reporting Requirements. The incident was determined to be an isolated incident and not a result of lack of care and supervision.

Per Title 22, division 12, chapter 1, no deficiencies cited in the areas observed today.

This report is to be made available to the public upon request.
LIC 9213 Notice of Site Visit to be posted for 30 days.

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ruby Ocegueda	TELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

LIC809 (FAS) - (06/04)

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