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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100407063
Report Date: 06/11/2019
Date Signed: 06/11/2019 02:15:27 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:YOUNG WORLD II INFANT & PRESCHOOL CENTERFACILITY NUMBER:
100407063
ADMINISTRATOR:JOSLYN DIXONFACILITY TYPE:
850
ADDRESS:2955 N. FOWLER AVENUETELEPHONE:
(559) 291-0342
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:48CENSUS: 20DATE:
06/11/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Assistant Site Supervisor - Irma VillaTIME COMPLETED:
02:25 PM
NARRATIVE
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On this date, Licensing Program Analysts (LPAs) Luisa Gavoutian and Stephanie Navarro conducted an unannounced case management - incident inspection. LPAs met with Assistant Site Supervisor Irma Villa and took a census. The purpose of today's inspection was to follow-up on two unusual incidents that occurred at the facility on May 2, 2019 and May 6, 2019.

LPAs spoke to Assistant Site Supervisor regarding the two incidents. During both incidents, children were given medical attention. Based on interviews with the Assistant Site Supervisor, the incidents appear to be isolated and not a result of lack of supervision.

LPAs discussed reporting requirements with Assistant Site Supervisor. Assistant Site Supervisor stated she understands that all unusual incidents/injuries must be reported to Community Care Licensing (CCL) by telephone within 24 hours and followed up by the written report (LIC624) within seven days. The unusual incidents that occurred on May 2, 2019 and May 6, 2019 were not reported to CCL by telephone within 24 hours. CCL received the written reports on May 7, 2019.

Per Chapter 1, Division 12, Title 22 of the California Code of Regulations, the following deficiency is found: (see LIC809-D). Exit interview was conducted with Assistant Site Supervisor Irma Villa.

Licensee was provided a copy of appeal rights.

This report must be made available to the public upon request.

LIC9213 Notice of Site Visit to be posted for 30 days.

SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa GavoutianTELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2019
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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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: YOUNG WORLD II INFANT & PRESCHOOL CENTER
FACILITY NUMBER: 100407063
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/11/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/18/2019
Section Cited
CCR
101212(d)
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Reporting Requirements. Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours...This requirement was not met as
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Licensee to review reporting requirement regulation and to submit written statement of understanding of reporting requirements to CCL by POC date 06/18/2019.
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evidenced by: Based on record review and interview, Licensee failed to report two unusual incidents/injuries within 24 hours to CCL by telephone or fax. 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: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa GavoutianTELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2019
LIC809 (FAS) - (06/04)
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