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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103801862
Report Date: 02/01/2024
Date Signed: 02/01/2024 03:28:53 PM


Document Has Been Signed on 02/01/2024 03:28 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:FUSD-PYLEFACILITY NUMBER:
103801862
ADMINISTRATOR:MADDEN, KATHERINEFACILITY TYPE:
850
ADDRESS:4140 N. AUGUSTATELEPHONE:
(559) 457-3690
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY:24CENSUS: 7DATE:
02/01/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Carol Martinez-GuzmanTIME COMPLETED:
03:40 PM
NARRATIVE
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On 2/1/2024, Licensing Program Analysts (LPA) Stephanie Vega-Gonzalez conducted an unannounced Case Management. The purpose of the inspection was to follow up on an incident report that was provided to the department on 11/28/2023 from the facility. Today, LPA met with Teacher, Carol Martinez-Guzman Staff 1, and Staff 2. LPA explained the reason for the inspection. LPA took a census and toured the facility. LPA interviewed staff, reviewed facility records, obtained facility records, and interviewed staff.

On today’s date LPA reviewed staff files. It was observed that Staff 3 did not have a complete personnel record on site for LPA to review.

Per California Code of Regulations, Title 22, Division 12, Chapter 1 , a deficiency is being on the attached LIC 9099D).



An exit interview was conducted with Teacher, Carol Martinez-Guzman.
A copy of this report and Appeal Rights were provided and discussed with Teacher, Carol Martinez-Guzman.
A Notice of Site Visit Form was posted to parent's board and must remain posted for 30 days.
SUPERVISOR'S NAME: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Stephanie Vega-GonzalezTELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2024
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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Document Has Been Signed on 02/01/2024 03:28 PM - It Cannot Be Edited

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: FUSD-PYLE
FACILITY NUMBER: 103801862

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/15/2024
Section Cited
CCR
101217(a)

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101217 Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement was not met as evidence by:
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Licensee stated that they will complete file for Staff 3 and submit it to the department by POC due date of 02/15/2024.
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Staff 3 did not have a complete personnel record. The following was missing: LIC503, copy of Mandated Reporter, Immunizations (MMR, TDAP, TB), educational units. This is a potential risk to the health, safety and personal rights of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Stephanie Vega-GonzalezTELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2024
LIC809 (FAS) - (06/04)
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