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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100406724
Report Date: 09/04/2024
Date Signed: 09/04/2024 10:35:53 AM

Document Has Been Signed on 09/04/2024 10:35 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:FRESNO EOC CLOVIS HEAD STARTFACILITY NUMBER:
100406724
ADMINISTRATOR/
DIRECTOR:		MUNOZ, JAMESFACILITY TYPE:
850
ADDRESS:510 BARSTOWTELEPHONE:
(559) 263-1205
CITY:CLOVISSTATE: CAZIP CODE:
93612
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 13DATE:
09/04/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:James MunozTIME VISIT/
INSPECTION COMPLETED:
10:40 AM
NARRATIVE
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On 09/04/2024, Licensing Program Analysts (LPAs) Jeovanna Yanez and Julio Rodriguez conducted an unannounced case management inspection. LPAs toured the facility and a census was taken. LPAs met with Center Director, James Munoz. The purpose of today's inspection was to discuss an incident that occurred on 8/22/2024, in which child #2 was left unsupervised in the facility restroom. This incident was reported to the Fresno Community Care Licensing Office on 8/26/24 by Program Support Specialist, Shawna Wilbourn.

During today's inspection, LPA's reviewed pertinent documentation and interviewed staff that was associated with the incident. Information obtained revealed during breakfast time, around 8:40 AM, two children left the breakfast area to use the facility restroom. Staff #1, Staff #2, and Director were all sitting at tables in the breakfast area attending to children; Staff #3 was near the restroom and had supervision of the children entering the restroom. Staff #3 then left the area to complete another task outside of the classroom and Child #1 was observed returning to the breakfast area, but child #2 remained in the restroom. Child #2 then came out of the restroom on their own. All staff in the classroom observed child return to the breakfast area on their own, and Staff #3 was advised by Director that the child was left unsupervised in the restroom. Child #2 was deemed safe by staff, but child #2’s guardians were not contacted. Director stated he was waiting on directives from upper management to disclose information regarding this incident to Child #2's guardian. ECE Specialist, Mai Amy Vang was also notified about the incident on 08/23/2024.

LPA observed the facility restroom area and observed the restroom to have a half-door where staff standing outside or near the area have direct supervision of the children. The restroom is located inside the classroom on the left hand side near the sink.

(CONTINUED ON 809-C)

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE: DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/04/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: FRESNO EOC CLOVIS HEAD START
FACILITY NUMBER: 100406724
VISIT DATE: 09/04/2024
NARRATIVE
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LPA determined that although adequate ratios were in place when the incident occurred, a lack of proper supervision resulted in the child being left unsupervised in the restroom for an undisclosed amount of time. This poses a potential risk to the health, safety, or personal rights of children in care.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D) Exit interview conducted with Director, James Munoz and a copy of appeal rights was provided.
SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024
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Document Has Been Signed on 09/04/2024 10:35 AM - It Cannot Be Edited


Created By: Jeovanna Yanez On 09/04/2024 at 08:18 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: FRESNO EOC CLOVIS HEAD START
FACILITY NUMBER: 100406724

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/02/2024
Section Cited
CCR
101229(a)(1)

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(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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Director Munoz stated staff will have a training pertaining to regulation 101229(a)(1); An agenda, Copy of training materials, and signed staff roster of attendees is to be completed and submitted to the Fresno Community Care Licensing (CCL) office by POC due date.
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This requirement is not met as evidenced by information obtained indicating that child #2 was left in the restroom for an undisclosed amount of time. This poses a potential risk to the health, safety, or personal rights of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Juvenal Moctezuma
LICENSING EVALUATOR NAME:Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:
DATE: 09/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2024


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