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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100407038
Report Date: 11/13/2019
Date Signed: 11/13/2019 03:30:55 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:FIREBAUGH-LAS DELTAS UNIFIED SCHOOL DISTRICTFACILITY NUMBER:
100407038
ADMINISTRATOR:SANCHEZ, DELIA M.FACILITY TYPE:
850
ADDRESS:1691 "Q" STREETTELEPHONE:
(559) 659-3117
CITY:FIREBAUGHSTATE: CAZIP CODE:
93622
CAPACITY:144CENSUS: 47DATE:
11/13/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Delia SanchezTIME COMPLETED:
03:45 PM
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On this date, Licensing Program Analyst (LPA) Angelica Slaughter conducted an unannounced inspection to the facility. LPA met with Early Learning Childhood Coordinator, Maria "Delia" Sanchez. The purpose of today's inspection was to follow up on an incident that was reported to Community Care Licensing (CCL) Fresno Regional Child Care Office. On 10/16/19, an incident report was made to the Duty Officer regarding Child #1 was walking up the stairs of the playground equipment, when her foot slipped and she hit her mouth on the stair. Child #1 sustained an abrasion to her bottom lip and top two teeth became loose. LPA conducted a tour of the facility and a census was taken. A series of questions was asked regarding the incident and it was discussed. Pictures were taken of the playground equipment where the incident occurred. Incident and information collected will be discussed with management in further detail to determine an appropriate plan of action, if needed.

Per California Code of Regulations Title 22 Chapter 22 Division 12 Chaper 3, there are no deficiencies being cited on this inspection.

Notice of Site Visit to be posted for 30 days.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Angelica SlaughterTELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2019
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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