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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153801986
Report Date: 11/07/2019
Date Signed: 11/07/2019 12:04:49 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:GREENFIELD CHILDREN'S CENTERFACILITY NUMBER:
153801986
ADMINISTRATOR:SHARON PHILLIPSFACILITY TYPE:
850
ADDRESS:5400 MONITORTELEPHONE:
(661) 831-1398
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY:24CENSUS: 23DATE:
11/07/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Erica Valdez, TeacherTIME COMPLETED:
12:20 PM
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A case management inspection was conducted today by Licensing Program Analyst, Pete Espinoza. LPA met with, Erica Valdez, Teacher, to discuss incident which occurred on 11/01/2019. 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 interviewed stated on Friday (11/01), Child lost his footing and tripped while turning around to leave group. Child fell forward hitting his head on the corner of the shelf. Staff observed small cut on forehead above eyebrow. Staff applied first aid and called parent. Mom arrived shortly and took Child directly to urgent care. Mom called later in day to inform staff that child received 4 stitches. Staff reported incident to Early Childhood Education Facilitator who reported incident to Fresno Regional Office by telephone. Staff provided copy of Student Accident Report and Patient Clinical Summary. There were 10 children in the room with a Teacher, Assistant and parent volunteer at time of incident. Child had follow-up appoint with doctor on Sunday (11/03) and returned to center on Monday (11/04).

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 Erica Valdez, Teacher.

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: 11/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019
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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