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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103808815
Report Date: 04/07/2022
Date Signed: 04/07/2022 01:00:09 PM


Document Has Been Signed on 04/07/2022 01:00 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:ST. AGNES CHILD DEVELOPMENT CENTERFACILITY NUMBER:
103808815
ADMINISTRATOR:PRICE, MARYELLENFACILITY TYPE:
830
ADDRESS:1255 E. HERNDON AVE.TELEPHONE:
5594503545
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:40CENSUS: 36DATE:
04/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Amanda TullerTIME COMPLETED:
01:20 PM
NARRATIVE
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On 4/7/22 Licensing Program Analyst (LPA) Caroline Harris conducted an unannounced case management inspection. LPA met with Interim Assistant Director, Amanda Tuller and a census was taken. The purpose of this report was to cite deficiencies that were observed during the inspection.

Upon observations of the 0-1 classroom, the LPA observed two infants sleeping in the sleeping area, one infant was sleeping in a crib and another infant was sleeping in a sleep sack on a cot on the floor, face down. Review of the infants file did not show any documentation of the child needing to be placed on a cot for sleeping due to safety reasons. The infants Needs and Service Plan was last updated on 1/22. The LPA observed one staff to be in the middle area of the room with five infants and another staff to be around the corner on the far side of the room changing another infants diaper. There was no staff supervising the sleeping infants. In classroom PT1, the LPA observed a child in the front classroom area off to the side, laying down behind a table. The staff were by the sink area and this child was not being supervised. The staff was asked to either move to that area to supervise or have the child move over with the other children. Lastly, the LPA discussed and pointed out to Ms. Tuller observations of staff not supervising children at all times when out on the play yard.

California Code of Regulations, Title 22, Division 12, Chapter 1, are being cited on the attached LIC 9099D.

An exit interview was conducted with Amanda Tuller. A printed copy of this report as well as appeal rights was provided to Ms. Tuller at the conclusion of the visit. A Notice of Site Visit is to be posted for 30 days.
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Caroline HarrisTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:
DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/07/2022
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 2


Document Has Been Signed on 04/07/2022 01:00 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: ST. AGNES CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 103808815

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
04/21/2022
Section Cited

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Care and Supervision. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1).
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This requirement was not met as evidenced by the LPA's observations as described in the 809 report. This is a possible risk to the health, safety or personal rights of children in care.
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Deficiency Dismissed
Type B
04/21/2022
Section Cited

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In addition to Section 101239.1, the following shall apply. A crib or portable-crib meeting United States Consumer Product Safety Commission safety standards shall be provided for each infant who is unable to climb out of a crib.
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Floor mats or cots that meet the requirements of Section 101239.1(b) shall be provided for all infants who have the ability to climb out of a crib. This requirement was not met as evidenced by LPA's observations on the 809 report. This is a possible risk to the health, safety or 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: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Caroline HarrisTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:
DATE: 04/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/07/2022
LIC809 (FAS) - (06/04)
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