<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103801209
Report Date: 10/25/2022
Date Signed: 10/26/2022 09:39:30 AM


Document Has Been Signed on 10/26/2022 09:39 AM - 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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:CASA CASTELLANOSFACILITY NUMBER:
103801209
ADMINISTRATOR:BENITEZ, MARTHAFACILITY TYPE:
850
ADDRESS:900 NEWMARK AVENUETELEPHONE:
(559) 646-0152
CITY:PARLIERSTATE: CAZIP CODE:
93648
CAPACITY:45CENSUS: 29DATE:
10/25/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Martha BenitezTIME COMPLETED:
01:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On this date, 10/25/22, Licensing Program Analyst (LPA) Gloria Reyes met with Site Supervisor, Martha Benitez for an unannounced Case Management- Incident inspection. LPA toured the facility and a census was taken. There are 29 children present. An Unusual Incident Report was submitted to the Fresno Community Care Licensing Office regarding an incident that occurred on 08/29/22, at approximately 09:18 AM, on the school play yard. Child #1, sustained an open wound on the back of the head near the left ear and required one stich. The child was sitting on a kids size wooden picnic table when the child pushed himself/herself backwards hitting himself/herself on a play kitchen sink. Staff immediately attended to the child and administered first aid. The child’s parents were contacted, parents picked up their child and child was taken to Advent's Health Center. The child was treated, released and returned to the center without restrictions.

Site Supervisor said that the wooden picnic bench was removed to prevent future accidents and she spoke to her staff about reminding children about outdoor safety rules. This was an isolated incident and the facility took appropriate measures.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

Exit interview conducted with Site Supervisor. This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Gloria ReyesTELEPHONE: (559) 341-4471
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1