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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153801755
Report Date: 01/26/2022
Date Signed: 01/26/2022 01:57:53 PM

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:LONGFELLOW ELEMENTARY SCHOOLFACILITY NUMBER:
153801755
ADMINISTRATOR:BARELLA, MICHAELFACILITY TYPE:
850
ADDRESS:1900 STOCKTON STREETTELEPHONE:
(661) 631-5350
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93305
CAPACITY:24CENSUS: 9DATE:
01/26/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Leticia Ochoa TIME COMPLETED:
02:15 PM
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On 01/26/21 Licensing Program Analyst (LPA) Araceli Gibson conducted an unannounced case management incident inspection. Classroom Census of 9 children. LPA Araceli Gibson, met with Principal Leticia Ochoa, Teacher Aurora Amavizca, and Simitrio Garza. LPA followed up on an incident that was reported to CCL on 10/15/21. The incident involved an injury to a preschool child. On 10/15/21 child was running and fell face first onto the concrete. Child had injuries to her mouth and had four teeth extracted by a dentist. Teacher Simitrio Garza witnessed the incident.

LPA Gibson observed the area and discussed with the Principal Leticia Ochoa preventive measures on how to keep the area from becoming a tripping hazard in the future.

The facility was providing adequate supervision during the incident, notified authorized representatives, and properly documented the incident with Community Care Licensing.

No deficiencies were issued for today's visit.

Exit interview conducted with the Principal Leticia Ochoa and Aurora Amavizca.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Araceli GibsonTELEPHONE: (559) 341-5860
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022
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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