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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103801143
Report Date: 11/27/2023
Date Signed: 11/27/2023 12:11:51 PM


Document Has Been Signed on 11/27/2023 12:11 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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:FRESNO EOC CARUTHERS HEAD STARTFACILITY NUMBER:
103801143
ADMINISTRATOR:PAREDES, ANGELINEFACILITY TYPE:
850
ADDRESS:2420 W. CLEMENCEAUTELEPHONE:
(559) 263-1205
CITY:CARUTHERSSTATE: CAZIP CODE:
93609
CAPACITY:50CENSUS: 22DATE:
11/27/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Angeline ParedesTIME COMPLETED:
12:25 PM
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On 11/27/2023, Licensing Program Analyst (LPA) Aurelio Mendoza conducted an unannounced case management inspection. LPA met with Center Director Angeline Paredes to discuss an unusual incident which occurred on 10/16/2023. On 10/16/2023 at approximately 8:40 am child #1 asked staff #1 if they could go get their sweater from their cubby while seated on a dinning table in Room B and child #1 stood up and ran to their cubby and lost their balance and fell forward hitting their lips on the children's cubbies which resulted in an injury where child #1 bit into their lower lip.

Through staff interviews, child interview, records reviews, and observations LPA discerned that this was an isolated event and that post the injury child #1 was cared for by facility staff and provided first aid promptly. Additionally, child #1's parent was contacted and informed in a timely fashion of the incident; child returned to care the following day on 10/17/2023.

A complete file review was conducted prior to visit. LPA toured facility inside and outside. LPA took a census, interviewed staff, interviewed child #1, and observed area in which incident occurred.

Based on the information obtained, LPA determined facility staff handled the incident correctly. LPA determined facility staff took appropriate measures to address the child's injury, followed proper policies and procedures and no regulations were violated.



Per California Code of Regulations Title 22, Division 12, no deficiency cited during today's inspection.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS
SUPERVISOR'S NAME: Cynthia BrannonTELEPHONE: (559) 650-7884
LICENSING EVALUATOR NAME: Aurelio MendozaTELEPHONE: (559) 815-8119
LICENSING EVALUATOR SIGNATURE:
DATE: 11/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/27/2023
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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