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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 163810031
Report Date: 12/18/2019
Date Signed: 12/18/2019 11:36:01 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:KCAO ARMONA LEARNING CENTERFACILITY NUMBER:
163810031
ADMINISTRATOR:AVILA, TERESAFACILITY TYPE:
850
ADDRESS:13835 LYN STTELEPHONE:
(559) 584-8946
CITY:ARMONASTATE: CAZIP CODE:
93202
CAPACITY:48CENSUS: 36DATE:
12/18/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Angie SotoTIME COMPLETED:
11:50 AM
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On this date, Licensing Program Analysts (LPAs) Ruby Ocegueda and Kathy Pacheco conducted an unannounced case management – unusual incident inspection. LPA's met with Angie Soto, Site Supervisor. LPA's 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 10/28/19. The Incident reported was regarding a child (see confidential names form LIC 811) tripping and fracturing his/her nose while climbing on the play structure in the play yard.

During today's inspection, LPAs interviewed site supervisor regarding the unusual incident, reviewed child's file, and inspected the outside equipment. LPA Ocegueda interviewed teacher (see LIC 811) via telephone on 11/13/19. LPA reviewed and confirmed the information reported on the Unusual Incident form LIC 624. Per Site Supervisor Soto, she continues to remind children to climb the structures as intended (climbing only one step at a time) and reminds the children to slow down while playing outside. LPA's verified that the play structure was intended to be used by children 2 years to 5 years of age. Site Supervisor stated that child has not had any further incidents or re-occurring injuries. Site supervisor provided LPAs with child's medical appointment print out, indicating information regarding the injury. LPA verified that the injury was consistent with what was reported to CCL. Site Supervisor also showed electronic records indicating that they were within ratio at the time and date of the incident. During todays inspection, LPAs determined that the facility met all reporting requirements as specified in Title 22 Regulation 101212 - Reporting Requirements. The incident was an isolated incident and not a result of lack of care and supervision.

No deficiencies cited in the areas observed today.

This report is to be made available to the public upon request.
LIC 9213 Notice of Site Visit to be posted for 30 days.
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ruby OceguedaTELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2019
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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