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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 163801067
Report Date: 02/19/2020
Date Signed: 02/21/2020 09:39:29 AM

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: 119DATE:
02/19/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Christina BursiagaTIME COMPLETED:
10:45 AM
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On 2/19/2020, Licensing Program Analyst (LPA) Kathy Pacheco conducted an unannounced case management inspection at the facility. LPA met with Administrator, Christina Bursiaga, to discuss an incident that occurred on 2/3/2020. LPA toured the facility, took a census, interviewed staff and children, and observed area in which the incident occurred.

On 2/3/2020, the children in classroom #7 were on the playground. At approximately 9:30 AM, child #1 (see Confidential Names form (LIC 811) dated 2/3/2020) was walking on the sidewalk near the water fountain. Child #1 stated she tripped on the cement and fell and hurt her lip. Staff #1 stated she saw child #1 as she was falling, but staff #1 did not see if child #1 was walking or running. Staff #1 said she went to child as soon as she saw her fall. Staff #2 stated she was also standing near child #1 and turned around when she heard her fall and start to cry. Staff #1 said child #1 was complaining about her lip hurting and staff #1 could see child #1's lip was already starting to swell. Staff #1 said she took child #1 to the sink to rinse her mouth out and that is when they saw blood in the sink. Staff #1 said the sink was disinfected as soon as child #1 was done rinsing her mouth. Staff #1 said they provided child #1 with an ice pack and called her parent immediately to inform parent of the incident. Staff said child #1's parent came to pick up child #1 and took her for medical attention. Staff stated child #1 did not require stitches and returned to school the next day.

Based on the information obtained, LPA determined Licensee handled the incident correctly and reporting requirements were met. After interviewing staff and children, and observing the area where the incident occurred, LPA determined Licensee took appropriate measures to address child #1's injury. LPA further determined Licensee 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.
Exit interview conducted with Administrator. A copy of this report and Notice of Site Visit (LIC 9213) were provided to the facility. LIC 9213 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: 02/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2020
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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