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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 160403101
Report Date: 11/10/2021
Date Signed: 11/10/2021 10:48:08 AM

Document Has Been Signed on 11/10/2021 10:48 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:LEMOORE PRESCHOOLFACILITY NUMBER:
160403101
ADMINISTRATOR:KAYLA RASBEARYFACILITY TYPE:
850
ADDRESS:118 N. HEINLEN STREETTELEPHONE:
(559) 924-7336
CITY:LEMOORESTATE: CAZIP CODE:
93245
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 16DATE:
11/10/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Kayla RasbearyTIME COMPLETED:
11:00 AM
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On 11/10/2021, Licensing Program Analyst (LPA) Ruby Ocegueda conducted an unannounced case management – unusual incident inspection. Before entering the facility, LPA conducted a Covid-19 safety screening. LPA met with Director Kayla Rasbear who oversees this facility which operates as a parent co-op. LPA toured the facility, and took a census. The purpose of today's inspection was to follow-up on an unusual incident that was reported to Community Care Licensing (CCL) on 10/27/2021. The Incident reported was regarding child#1 who fell off a plasma car in the play yard on 10/26/2021 causing him/her to hit the back of his/her head resulting in a small open wound. On the day of the incident there were 9 children present and two staff.

During today's inspection, LPA interviewed staff, reviewed personnel files, reviewed file of child #1 and inspected play equipment and the outside play area where the incident occurred. LPA observed adequate visual supervision today with each group of children supervised by a staff or volunteer parent. Since the incident, Director Kayla indicated that they have not used the plasma cars. LPA indicated that the use of the plasma cars could resume if the staff wished, however a reminder to children should be conducted regularly to avoid any tilting back so as to avoid falling. Staff supervision and close proximity to the children should continue while indoors and outdoors from both staff and parent volunteers. Today, LPA determined that the facility met all reporting requirements as specified in Title 22 Regulation 101212 - Reporting Requirements, including notifying CCL and the parent (per file review and interview). The incident is an isolated incident and not a result of lack of care and supervision.

Per California Code of Regulations Title 22, Division 12, no deficiencies were cited today.

A COPY OF THIS REPORT MUST REMAIN IN THE FACILITY FOR PUBLIC REVIEW.
NOTICE OF SITE VISIT FORM (LIC 9213) POSTED TO PARENT'S BOARD.

To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE: DATE: 11/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/10/2021
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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