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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203801180
Report Date: 01/29/2020
Date Signed: 02/06/2020 11:14:27 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:SIERRA VISTA MIGRANT HEAD STARTFACILITY NUMBER:
203801180
ADMINISTRATOR:SANDOVAL, SYLVIAFACILITY TYPE:
850
ADDRESS:917 E. OLIVE AVENUETELEPHONE:
(559) 675-8620
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY:88CENSUS: 57DATE:
01/29/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Lina BojorquezTIME COMPLETED:
03:20 PM
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Licensing Program Analyst (LPA) Juvenal Moctezuma conducted case management inspection regarding the self reported incident that occurred on 01/13/2020 with Child #1. LPA met with Site supervisor, Lina Bojorquez and area Manager, Norma Blanco and explained the reason of the inspection. LPA toured the facility, took a census, and interviewed the Staff and Child #1.

According to interviews obtained, Staff #1 stated that they noticed that child #1's behavior was unusual when Staff #2 entered the room. Staff #1 stated that they did not know why since Staff #2 does not have any contact with Child #1. Staff #1 stated that after the incident they noticed that child #1 would act that way anytime a male enters the room even when LPA came and conducted the inspection today. A Social Worker also came and spoke to child #1. Based on interviews obtained, it was determined that the child does not have contact with staff #2.

This appears to be an isolated incident and staff took appropriate measures to address the situation, following appropriate Agency policies and reporting procedures.

BASED UPON INFORMATION THAT WAS OBTAINED FROM THE LICENSEE AND INTERVIEWS CONDUCTED, IT IS DETERMINED THAT THERE WERE NO VIOLATIONS OF CCL REGULATIONS. NO FURTHER ACTION IS REQUIRED AT THIS TIME.

Site Visit Notice posted on the parent board. Exit interview was conducted.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
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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