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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153808206
Report Date: 06/20/2023
Date Signed: 06/20/2023 11:53:40 AM


Document Has Been Signed on 06/20/2023 11:53 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
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:ST. JOHN'S CHILDREN CENTERFACILITY NUMBER:
153808206
ADMINISTRATOR:MOSLEY, CHERIFACILITY TYPE:
830
ADDRESS:4500 BUENA VISTA ROADTELEPHONE:
(661) 664-9127
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:24CENSUS: 8DATE:
06/20/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Cheri MoselyTIME COMPLETED:
12:15 PM
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On June 20, 2023 Licensing Program Analyst conducted an unannounced case management visit to follow up on an incident report that was received by the Fresno South Regional Office on May 18, 2023 regarding Child #1 (C1) possibly choking on a piece of ice. LPA McWilliams met with Director Cheri Mosely and informed her of the reason for the inspection. A tour of the facility was completed inside and out and a census was taken.

On May 18, 2023 staff member called to report that C1 was playing outside in water tables that the teachers had put ice cubes in and one of the other children splashed C1 causing C1 to take a breath in. It is reported that C1 made a noise and went limp and that is when Staff #1 (S1) picked C1 up and turned C1 over and provided back slaps. C1 started to cry and was able to be calmed down and was reported to be back to normal. Staff called both parents and left messages regarding the incident immediately.

Both parents picked C1 up from the facility around lunch time, it is reported that parents took C1 home and C1 napped and was taken to urgent care over the weekend. It is reported that the doctor cleared C1 with no injuries due to the incident. Parents emailed staff the following day as well and thanked them for the quick response to C1 and the incident.

Director Mosely confirmed that there was 4 staff outside at the time of the incident and there was a total of 13 infants outside. S1 stated that there was two different tables with water while only one table had ice cubes in it and that the tables were close to each other. It was reported that all of the children and staff were at the water tables when the incident occurred. S1 stated that staff is unsure if the child choked on ice or had an incident where C1 held her breath as C1 did not gag, cough or throw up during the incident and no ice was observed while the back slaps were being performed.

Continued on following page 809-c
SUPERVISOR'S NAME: Luisa GavoutianTELEPHONE: (559) 650-7879
LICENSING EVALUATOR NAME: Kari McWilliamsTELEPHONE: (559) 341-4724
LICENSING EVALUATOR SIGNATURE:
DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: ST. JOHN'S CHILDREN CENTER
FACILITY NUMBER: 153808206
VISIT DATE: 06/20/2023
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Director Mosely and S1 have confirmed that the center no longer uses ice as a part of the sensory water tables; they have started to use the choking measurement tool to ensure that everything that is provided to the infants is measured to ensure that this incident or other choking hazards are not accessible to infants.

C1 returned to the facility the following day, Friday May 19, 2023 with no issues.

Due to being in ratio, the number of staff present and at the water tables with the infants, the reaction and response of the staff of the incident was appropriate.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, no deficiencies are cited.

Exit interview and report reviewed with Director Cheri Mosely.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days
SUPERVISOR'S NAME: Luisa GavoutianTELEPHONE: (559) 650-7879
LICENSING EVALUATOR NAME: Kari McWilliamsTELEPHONE: (559) 341-4724
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
LIC809 (FAS) - (06/04)
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