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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153801741
Report Date: 03/09/2022
Date Signed: 03/09/2022 09:45:27 AM


Document Has Been Signed on 03/09/2022 09:45 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:GREENFIELD STATE PRESCHOOLFACILITY NUMBER:
153801741
ADMINISTRATOR:HERNANDEZ, ROSITAFACILITY TYPE:
850
ADDRESS:5400 MONITOR STREET BLDG. BTELEPHONE:
(661) 398-0426
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY:48CENSUS: 30DATE:
03/09/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Rosita Hernandez, Site SupervisorTIME COMPLETED:
10:00 AM
NARRATIVE
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On 03/09/2022, a case management inspection was conducted by Licensing Program Analyst, Pete Espinoza (LPA). LPA met with, Rosita Hernandez, Site Supervisor, to discuss incident which occurred on 02/18/2022. A complete file review was conducted prior to visit. LPA toured facility inside and outside. Census was taken. LPA interviewed staff and observed area in which incident occurred.

Staff stated there were two (2) staff supervising 14 children in outside play area. Staff stated when coming into classroom from play area, child hid inside play structure when lining up to come inside. Staff stated they brought children inside classroom and did not realize child was left alone in play area for less than two (2) minutes. Staff stated they informed parent of incident and notified Fresno Regional Office, via telephone.

California Code of Regulations, Title 22, Division 12, Chapter (1/3), are being cited on the attached LIC 9099D.

An exit interview was conducted with Rosita Hernandez, Site Supervisor, a plan of correction was discussed, and appeal rights were explained. A printed copy of this report as well as a printed copy of the appeal rights was provided at the conclusion of the visit.

Notes:
* Any Licensing reports indicating a Type A deficiency shall be posted immediately and for the next 30 days and copies provided of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months 1596.8595(c). Health & Safety Section 1596.859(a) shall be cited and a civil penalty of $100.00 for failure to provide copies to parents/guardians of children in care and newly enrolled children, and for failure to maintain written verification of receipt of licensing reports indicating a Type A violation (LIC 9224).
LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
To order forms, etc. visit our website at www.ccld.ca.gov.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Peter EspinozaTELEPHONE: 661-644-8231
LICENSING EVALUATOR SIGNATURE:
DATE: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2022
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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Document Has Been Signed on 03/09/2022 09:45 AM - 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: GREENFIELD STATE PRESCHOOL
FACILITY NUMBER: 153801741

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/11/2022
Section Cited

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Responsibility for Providing Care and Supervision: No child shall be left without the supervision of a teacher at any time... Supervision shall include visual observation. This requirement is not met as evidenced by interviews with staff conducted during today’s inspection/.
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Staff stated a child was left in outside play area alone for less than two (2) minutes. This poses an immediate 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: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Peter EspinozaTELEPHONE: 661-644-8231
LICENSING EVALUATOR SIGNATURE:
DATE: 03/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2022
LIC809 (FAS) - (06/04)
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