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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153808652
Report Date: 10/19/2023
Date Signed: 10/19/2023 12:10:48 PM


Document Has Been Signed on 10/19/2023 12:10 PM - 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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:MAOF CESAR CHAVEZ PRESCHOOLFACILITY NUMBER:
153808652
ADMINISTRATOR:ORTIZ, NANCYFACILITY TYPE:
850
ADDRESS:410 CHANNA DRTELEPHONE:
(661) 778-6150
CITY:DELANOSTATE: CAZIP CODE:
93215
CAPACITY:154CENSUS: 78DATE:
10/19/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Nancy OrtizTIME COMPLETED:
12:30 PM
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On 10/19/2023, Licensing Program Analysts (LPAs) Gloria Reyes and Lady Cabrera met with Site Supervisor, Nancy Ortiz for an unannounced Case Management Inspection-incident. A complete file review was conducted prior to today's inspection. LPAs toured the facility, and a census was taken.

On 10/16/2023, the facility notified Community Care Licensing Office (CCL) via telephone regarding an Unusual Incident, involving a day-care child who fell and sustained an open wound between the eyebrows. The child was running on the soft foam playground when the child fell onto a wooden activity cube toy. The director immediately removed the wooden toy and advised her staff to not use as an outside toy. Staff #1 witnessed the incident and was standing next to the child. Staff #1 immediately reacted and applied pressure on the wound. The Site Supervisor was contacted via the walkie-talkie and called 911. The child was transported to the hospital where the child received two stiches. The child was released without restrictions.

Today, LPAs inspected the area where the incident took place. LPAs did not observe any hazards. This appears to be an isolated incident and staff took appropriate measures to address the child’s injury following appropriate Agency policies and procedures. The director is also meeting with her staff to review playground rules and safe toys for outdoor use. LPAs were provided a copy of the LIC 624

Exit interview conducted and report was reviewed with Site Supervisor, Nancy Ortiz. Appeal rights were provided.

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

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: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Gloria ReyesTELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:
DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2023
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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