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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153801769
Report Date: 02/07/2020
Date Signed: 02/07/2020 12:25:10 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:MAOF CHILD CARE CENTER PRESCHOOLFACILITY NUMBER:
153801769
ADMINISTRATOR:ORTIZ, NANCYFACILITY TYPE:
850
ADDRESS:715 E. CALIFORNIA AVENUETELEPHONE:
(661) 328-6921
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY:72CENSUS: 53DATE:
02/07/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Carla Benitez, Site SupervisorTIME COMPLETED:
12:30 PM
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A case management inspection was conducted today by Licensing Program Analyst, Pete Espinoza. LPA met with, Carla Benitez, Site Supervisor, to discuss incident which occurred on 01/28/2020. 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 on Tuesday (01/28) they were outside with approximately 15-16 children and two (2) staff. Staff stated they observed child walking down stairs of structure, bleeding from the forehead. Staff stated they took child inside and applied first aid and notified Site Supervisor. Staff stated child told them another child threw a plastic sign at her and hit her on the forehead. Site supervisor stated she called mom and mom arrived shortly to pick up child. Site Supervisor stated mom told her she was going to take child directly to urgent care. Site Supervisor stated the following day (01/29) Mom told her child received 2 stitches on her forehead. Site Supervisor stated although child received doctor's release to return to center on Thursday (01/30), mom decided to keep child home until Friday (01/31). Child returned to center on Monday (02/03).

Site Supervisor provided copies of Agency Injury Notification and School Note from medical provider.

Teacher-Child ratio was reportedly in place when the incident took place. Based on the information obtained, this appears to be an isolated incident and Staff took appropriate measures to address the child's injury, following proper policies and procedures and no regulations were violated.

Per California Code of Regulations Title 22, Division 12, no deficiency cited during today's visit. Exit interview conducted with the Carla Benitez, Site Supervisor.

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: 02/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2020
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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