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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103801763
Report Date: 08/28/2023
Date Signed: 08/28/2023 12:40:03 PM

Document Has Been Signed on 08/28/2023 12:40 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:KERMAN MIGRANT CENTERFACILITY NUMBER:
103801763
ADMINISTRATOR:HINOJOSA, ANAFACILITY TYPE:
850
ADDRESS:14660 W. G STREETTELEPHONE:
(559) 846-5351
CITY:KERMANSTATE: CAZIP CODE:
93630
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 21DATE:
08/28/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Ana HinojosaTIME COMPLETED:
01:00 PM
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On 8/28/23, Licensing Program Analyst (LPA) Priscilla Zamudio and Licensing Program Manager (LPM) Cynthia Brannon conducted an unannounced case management inspection. LPA met with Ana Hinojosa, Site Supervisor to discuss an incident which occurred on 7/31/23 and a census was also taken. LPA interviewed staff, reviewed files and observed where the incident occurred.

On 7/31/23, at approximately 9:30 am, there were 2 children playing inside during free choice when child #1 got the playhouse wood broom and hit child#2 over the head resulting in a bump with a small open wound.
Staff reported they immediately approached Child#2 to clean the area and applied an icepack. Another staff contacted the parent to inform about the injury and to make the decision of having the child stay or picking up. On 8/1/23, child#2 vomited at the end of the day. Mom was informed of the incident and picked up the child. The facility was later notified on 8/4/23 that child#2 was taken to ER on 8/1/23 and diagnosed with a mild concussion.

Site Supervisor made the initial report by telephone on 8/9/23 and submitted a written report on 8/10/23. Site Supervisor acknowledged the report was not made in a timely manner and understands the requirements. She provided a training to staff and reviewed the reporting requirements regulations in order to ensure reports are made as required.

Also during today's inspection, LPA & LPM observed synthetic grass in the outdoor activity space under the fall zones and discussed that it may not be adequately cushioned. LPA recommended a play yard inspector to inspect the cushioning under the climbing areas to ensure that it meets Title 22 requirements.

CONTINUED LIC 809-C
SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Priscilla Zamudio
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: KERMAN MIGRANT CENTER
FACILITY NUMBER: 103801763
VISIT DATE: 08/28/2023
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Based on information gathered and observations made by LPA & LPM, there were no obvious concerns or hazards found. Staff are implementing adequate care and supervision at the facility.

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

Exit interview conducted and report was reviewed with Ana Hinojosa, Site Supervisor.

This report shall be made available to the public upon request. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Priscilla Zamudio
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023
LIC809 (FAS) - (06/04)
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