<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 150407803
Report Date: 08/16/2022
Date Signed: 08/16/2022 10:46:37 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/22/2022 and conducted by Evaluator Nancy Her
PUBLIC
COMPLAINT CONTROL NUMBER: 57-CC-20220622111840

FACILITY NAME:TREVINO FAMILY DAY CAREFACILITY NUMBER:
150407803
ADMINISTRATOR:TREVINO, VIKKIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 871-6914
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93305
CAPACITY:14CENSUS: 14DATE:
08/16/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Courtney ThomasTIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Incident involving day care child was not reported.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 08/16/2022 Licensing Program Analyst (LPA) Nancy Her conducted an unannounced complaint investigation to deliver the findings of the above allegation. LPA met with Assistant Courtney Thomas due to Licensee Vikki Trevino not being available and a census was taken.

This agency has investigated the complaint alleging Incident involving day care child was not reported. Based upon information gathered through interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Per Title 22, Division 12, Chapter 3 of the California Code of Regulations, the following deficiency is being cited.

Exit interview conducted with Assistant Courtney Thomas.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 341-5422
LICENSING EVALUATOR NAME: Nancy HerTELEPHONE: (559) 341-5422
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 57-CC-20220622111840
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: TREVINO FAMILY DAY CARE
FACILITY NUMBER: 150407803
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/19/2022
Section Cited
CCR
102416.2(f)(1)
1
2
3
4
5
6
7
(1) Any injury suffered by a child in care shall be reported to that child's parent or authorized representative regardless of treatment by a medical professional.

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee will complete a statement regarding how Licensee will prevent this from happening in the future and submit statement to Fresno Community Care Licensing by 08/19/2022.
8
9
10
11
12
13
14
Based on interviews, staff members stated that they forgot to mention injury to child’s parent or authorized representatives which posed a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Duane MatsubaraTELEPHONE: (559) 341-5422
LICENSING EVALUATOR NAME: Nancy HerTELEPHONE: (559) 341-5422
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3