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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103808969
Report Date: 07/06/2022
Date Signed: 07/06/2022 10:19:09 AM


Document Has Been Signed on 07/06/2022 10:19 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-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:NANCY FULLER CHILDREN'S UNIVERSITY, INCFACILITY NUMBER:
103808969
ADMINISTRATOR:FULLER, NANCYFACILITY TYPE:
830
ADDRESS:7901 N CEDAR AVETELEPHONE:
(559) 447-5865
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:12CENSUS: 10DATE:
07/06/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Assistant Director, Beth Nelson Director and Opperations, Becky DritzTIME COMPLETED:
10:30 AM
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On 7/6/22 Licensing Program Analyst (LPAs) Caroline Harris conducted an unannounced case management visit. LPA met with Beth Nelson and Becky Dritz and a census was taken. The purpose of this report is to discuss possible deficiencies that were observed during a prior inspection. Upon records review, there was not proper documentation of child #1 behaviors/tantrums in the file. There was no documentation of any behaviors on enrollment papers, needs and service plan or child's preadmission health history. The facility was aware of the child's behavior at enrollment, as the parent informed them verbally, however nothing was documented. The LPA and Beth Nelson and Becky Dritz went over enrollment forms and discussed the importance of developing/reviewing these forms with the parent and also documenting behaviors.

Per California Code of Regulations Title 22, Division 12, Chapter 1, no deficiency was cited during today's visit.

An exit interview was conducted with Beth Nelson and Becky Dritz A copy of this report was provided to Beth Nelson and Becky Dritz at the conclusion of the visit. A Notice of Site Visit is to be posted for 30 days.
SUPERVISOR'S NAME: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Caroline HarrisTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:
DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2022
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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