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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 163902876
Report Date: 04/03/2024
Date Signed: 04/03/2024 11:41:37 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/02/2024 and conducted by Evaluator Adrian Pizano
PUBLIC
COMPLAINT CONTROL NUMBER: 57-CC-20240202103804

FACILITY NAME:DAMON, ANDREA FAMILY CHILD CAREFACILITY NUMBER:
163902876
ADMINISTRATOR:DAMON, ANDREAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 375-3716
CITY:HANFORDSTATE: CAZIP CODE:
93230
CAPACITY:14CENSUS: 10DATE:
04/03/2024
UNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Andrea DamonTIME COMPLETED:
12:10 PM
ALLEGATION(S):
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Licensee did not prevent day care child from engaging in inappropriate behaviors.
INVESTIGATION FINDINGS:
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On 04/03/2024, Licensing Program Analyst (LPA) Adrian Pizano conducted an unannounced complaint inspection to provide findings. LPA met with Licensee, Andrea Damon who accompanied LPA during tour of facility. LPA discussed the allegation and took a census. During the investigation, witnesses revealed SUBSTANTIATED. Based upon observations, and information gathered through interviews it has been determined that Child 1 pulled Child 2’s right side braid out, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. Per California Code of Regulations, Title 22, Division 12, Chapter 3, this deficiency is being cited on the attached LIC 9099D.

An exit interview conducted with Licensee, Andrea Damon. A copy of this report and Appeal Rights were provided and discussed with Licensee. A Notice of Site Visit Form was posted to parent's board and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
Substantiated
Estimated Days of Completion: 30
SUPERVISOR'S NAME: Luisa GavoutianTELEPHONE: (559) 650-7879
LICENSING EVALUATOR NAME: Adrian PizanoTELEPHONE: (559) 977-8435
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 57-CC-20240202103804
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: DAMON, ANDREA FAMILY CHILD CARE
FACILITY NUMBER: 163902876
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/03/2024
Section Cited
HSC
102423(a)(4)
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Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative...(4)...infliction of pain... This requirement was not met as evidenced by:
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Licensee will review personal rights regulation and have all staff review Personal Rights video on the CCLD website. Licensee will submit to Fresno South Regional Office signatures of all staff that have reviewed the personal rights regualtion and video by 04/05/2024.
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Based on interviews, Child 1 pulled Child 2's right side braid out. This poses a potential risk to health, safety, and/or personal rights to children in care
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Luisa GavoutianTELEPHONE: (559) 650-7879
LICENSING EVALUATOR NAME: Adrian PizanoTELEPHONE: (559) 977-8435
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3