103801141-3-10-2020-04-CC-RMAS-BMKPUX-20200310113815

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103801141
Report Date: 03/10/2020
Date Signed: 03/10/2020 11:38:20 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 JEFFERSON HEAD START		FACILITY NUMBER:	103801141
ADMINISTRATOR:	GOMEZ, ADRIANA		FACILITY TYPE:	850
ADDRESS:	1240 E. WASHINGTON STREET		TELEPHONE:	(559) 637-0025
CITY:	REEDLEY	STATE: CA	ZIP CODE:	93654
CAPACITY:	92	CENSUS: 65	DATE:	03/10/2020
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Adriana Gomez		TIME COMPLETED:	11:40 AM

NARRATIVE

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On 03/10/2020 Licensing Program Analyst (LPA) Rene Mancinas JR conducted an unannounced case management inspection and met with Director, Adriana Gomez. The purpose of today’s inspection was to follow up on an incident that was reported to the Department on 02/21/2020 regarding child #1 informing staff #1 of an issue regarding their [other] day care provider. It should be noted child #1 attends this facility on a part time basis. Parent of child #1 was notified of the incident. Staff #1 contacted Fresno County Child Protective Services (CPS) and completed a Suspected Child Abuse Report form, as required of child abuse mandated reporters. Fresno County CPS provided facility with a

"Does not meet the State requirements for intervention” response. Facility Education Liason, Kiana Neal, reported the incident to this Department on 02/21/2020.

Facility staff #2 also conducted a home visit at child #1’s home where the incident was further discussed. Staff #2 discussed the incident in greater detail with the parent, who stated she did not have concerns regarding child #1’s other day care provider. The other day care provider’s identifying information was never disclosed to staff by parent.

During today’s inspection, LPA talked to staff members and child #1. Child #1 was unable to disclose any identifying information regarding the other day care provider. Child #1 did state however, that she felt “safe” at her other day care provider. LPA contacted parent of child #1 and informed of the reason for contact. Parent did not feel comfortable providing LPA with other provider's information.

(Continued on 809-C)

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene Mancinas	TELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020

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 JEFFERSON HEAD START	FACILITY NUMBER: 103801141
	VISIT DATE: 03/10/2020

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Facility took the appropriate measures in notifying parent of child #1, Fresno County CPS, and this Department of the incident. LPA informed Director, Adriana Gomez, that incidents are to be reported to the Department within 24 hours or by the next business day. A written LIC 624 ‘Unusual Incident/Injury’ report is also to be submitted to Community Care Licensing (CCL) within 7 days of initially reporting to the Department. Also, when any Suspected Child Abuse Reports are completed to local CPS agencies, then a copy should be submitted to (CCL) as well for cross reporting purposes.

Per California Code of Regulations Title 22 Division 1, no deficiency is being cited today. Exit interview conducted with Director, Adriana Gomez. Notice of Site Inspection to be posted for 30 days.

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene Mancinas	TELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020

LIC809 (FAS) - (06/04)

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