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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100407094
Report Date: 11/08/2021
Date Signed: 11/08/2021 11:25:16 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:FRESNO EOC SAN JOAQUIN HEAD STARTFACILITY NUMBER:
100407094
ADMINISTRATOR:HERNANDEZ, SELENAFACILITY TYPE:
850
ADDRESS:8535 SOUTH NINTHTELEPHONE:
(559) 693-4571
CITY:SAN JOAQUINSTATE: CAZIP CODE:
93660
CAPACITY:20CENSUS: 6DATE:
11/08/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Nancy Garcia / Selena HernandezTIME COMPLETED:
11:30 AM
NARRATIVE
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On 11/08/21, Licensing Program Analyst (LPA) Angelica Slaughter, conducted an unannounced Case Management inspection to the facility. LPA toured the facility and a census was taken. Director was unavailable, therefore, LPA met with Teacher III Nancy Garcia and spoke to Director Selena Hernandez by telephone. The purpose of this inspection was to discuss the issue of non-reporting of unusual incidents to Community Care Licensing as required by the department.

Per California Code of Regulation, Title 22, Division 12, a deficiency is being cited (continued on 9099 D). Appeal rights were provided. A Notice of Site Visit (LIC 9213) was given.

This report shall be made available to the public upon request.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Angelica SlaughterTELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021
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 EOC SAN JOAQUIN HEAD START
FACILITY NUMBER: 100407094
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/12/2021
Section Cited

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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. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.
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This requirement was not met as evidenced by: record review and staff interview. Facility failed to report an unusual incident to the department as required. This posses a potential risk to the health, safety and/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: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Angelica SlaughterTELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2021
LIC809 (FAS) - (06/04)
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