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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103801141
Report Date: 05/25/2022
Date Signed: 05/25/2022 03:03:09 PM


Document Has Been Signed on 05/25/2022 03:03 PM - It Cannot Be Edited

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 STARTFACILITY NUMBER:
103801141
ADMINISTRATOR:DALIA CUEVASFACILITY TYPE:
850
ADDRESS:1240 E. WASHINGTON STREETTELEPHONE:
(559) 263-1205
CITY:REEDLEYSTATE: CAZIP CODE:
93654
CAPACITY:92CENSUS: 17DATE:
05/25/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Director, Dalia CuevasTIME COMPLETED:
03:00 PM
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On 5/25/2022, Licensing Program Analyst (LPA) Jose Penate conducted a Case Management - Incident inspection for an incident which occurred on 5/10/22. LPA met with Site Supervisor, Dalia Cuevas. LPA toured facility inside and outside and took census.

Teacher Assistant (TA), Micaela Salcedo stated that child #1 was rough playing on top of the play structure with other classmates. TA attempted to gather child #1 from the top of the play structure and she was unable to retrieve the child because he ran away. TA then took child #2 instead due to her being upset. TA stated that when she and child #2 were walking down the stairs she was unable to see the incident entirely due to her back being towards child #1. TA stated that all she heard was a cry out loud and at this point child #2 was already on the floor.

Teacher, Nora Alvarez stated that she did not see or hear any of the incident that was happening because she was observing other children at play. Teacher stated that she was the person who assisted the child after hearing his cry. Teacher stated that she was the staff member to assist the child with his injuries and was able to apply ice pack and give him the attention needed.

LPA toured play area for any obstructions that would not allow proper supervision by staff. LPA observed all furniture and equipment is placed in proper locations to allow visual supervision at all times. LPA observed proper cushion in the play area, but LPA recommended to have new wood chips installed for more cushioning. LPA informed site supervisor that adding padding could prevent major injuries to children while playing on structure. LPA observed on todays visit that proper supervision was being conducted while outdoor play.

Per Chapter 1, Division 12, Title 22 of the California Code of Regulations no deficiencies are observed today.

Exit interview was conducted with Site Supervisor, Dalia Cuevas.

SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Jose PenateTELEPHONE: (559) 341-5860
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2022
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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