<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 163801067
Report Date: 10/02/2019
Date Signed: 10/02/2019 02:37:24 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:PRESTON J. GREEN, SR., LEARNING CENTERFACILITY NUMBER:
163801067
ADMINISTRATOR:BURSIAGA, CHRISTINAFACILITY TYPE:
850
ADDRESS:11411 SOUTH ELEVENTH AVENUETELEPHONE:
(559) 582-5184
CITY:HANFORDSTATE: CAZIP CODE:
93230
CAPACITY:170CENSUS: 149DATE:
10/02/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Christina BursiagaTIME COMPLETED:
11:15 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On this date, Licensing Program Analyst (LPA) Kathy Pacheco conducted an unannounced case management inspection at the facility and met with Administrator, Christina Bursiaga, to discuss an incident which occurred on 9/23/19. LPA toured the facility inside and outside, took a census, interviewed staff, and observed the area in which the incident occurred.

At approximately 9:15 AM on 9/23/19 in classroom #5, child #1 (see Confidential Names Form (LIC 811) dated 10/2/19) was playing in the dramatic play area with a small wooden doll crib. The crib has four legs that raise the crib approximately one foot from the floor. Teacher Sandra Ordaz was observing child #1 playing with the crib when he stood on top of the crib. As Teacher Ordaz was warning child #1 to step off of the crib so he would not hurt himself, child #1 lost his footing and fell to the floor. Teacher Ordaz immediately went to check on child #1. She stated child #1 was holding his hand to his chin as she asked him if he was okay. Teacher Ordaz said when child #1 removed his hand from his chin, she saw blood and a small gash. She stated she immediately cleaned child #1's chin and she placed gauze over the cut. Teacher Ordaz said child #1's parent was contacted within a few minutes of the incident and the parent came within approximately 15 minutes to pick up child #1 and take him to the doctor. She said child #1 received dissolvable stitches and he returned to school the next day. Teacher Ordaz stated they have never had an issue with the wooden crib before, but they have now removed the wooden crib from the play area. She said they will occasionally bring the wooden crib out for the children to play with, but they always make sure a teacher is standing directly by the wooden crib to observe the children playing.

Based on the information obtained, LPA determined Licensee handled the incident correctly and reporting requirements were met. LPA further determined Licensee took appropriate measures to address the child's injury, followed proper policies and procedures, and no regulations were violated.
Per California Code of Regulations Title 22, Division 12, no deficiency cited during today's inspection.
LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Kathy PachecoTELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1