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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 150407493
Report Date: 03/27/2023
Date Signed: 03/27/2023 01:07:58 PM


Document Has Been Signed on 03/27/2023 01:07 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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:OWENS ELEMENTARY SCHOOL PREKFACILITY NUMBER:
150407493
ADMINISTRATOR:ARREDONDO, SARITAFACILITY TYPE:
850
ADDRESS:815 POTOMAC AVENUETELEPHONE:
(661) 631-4936
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY:24CENSUS: 12DATE:
03/27/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Sheila TrinidadTIME COMPLETED:
01:15 PM
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On March 27, 2023 Licensing Program Analyst (LPA) Kari McWilliams conducted an unannounced case management visit and met with Facility Representative Sheila Trinidad. LPA toured the facility and a census was taken.

LPA McWilliams discussed the purpose of today's inspection was due to an incident report date February 28, 2023 that was sent in to the Fresno South Regional Office in which child #1 (C1) was playing outside and was "knocked off the bottom of the slide" by another student. C1 fell in the woodchips and it was determined later that evening that C1 broke their elbow. During today's inspection LPA McWilliams observed the slide area and the woodchips in place at the bottom of the slide; LPA observed that there was adequate amount of wood chips in the area. The slide is age appropriate. LPA spoke to the staff member, Mr Gamino who witnessed the incident of C1 falling off the slide. Mr. Gamino stated that he was on the top of the structure over seeing the slide area and had requested C1 to move off of the bottom of the slide a couple of times; with no compliance from C1. Mr. Gamino confirmed that he witnessed the incident of child #2 (C2) going down the slide so fast that he didn't have a chance to tell C2 not to go down the slide. Mr Gamino stated that C1 was immediately attended to after the incident. Mr. Gamino stated that there was 11 children, two staff and a parent outside when the incident took place.

With an appropriate amount of wood chips under the slide and around the slide area as well as the amount of staff that was present when the child fell and direct supervision by Mr. Gamino; it is determined to be an isolated incident.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, no deficiencies are cited.
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.
Exit interview conducted and report was reviewed with the Facility Representative, Sheila Trinidad.
SUPERVISOR'S NAME: Luisa GavoutianTELEPHONE: (559) 650-7879
LICENSING EVALUATOR NAME: Kari McWilliamsTELEPHONE: (559) 341-4724
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2023
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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