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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203801195
Report Date: 01/21/2020
Date Signed: 01/21/2020 02:15:42 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:CHOWCHILLA HEAD STARTFACILITY NUMBER:
203801195
ADMINISTRATOR:BRAVO, MARTHAFACILITY TYPE:
850
ADDRESS:265 HOSPITAL DRIVETELEPHONE:
(559) 665-0291
CITY:CHOWCHILLASTATE: CAZIP CODE:
93610
CAPACITY:40CENSUS: 21DATE:
01/21/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Martha Bravo - DirectorTIME COMPLETED:
02:30 PM
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On 1/21/2020, Licensing Program Analyst (LPA), Joseph Pacheco arrived at the facility to conduct a Case Management inspection regarding an incident that occurred in the facility on 11/14/2019. LPA met with Director, Martha Bravo who stated that on the day of the incident, staff observed Child #1 having a diaper rash. Child #1 was taken to the doctor by their mother and was given ointment to treat the diaper rash. Mother informed staff that Child #1 was allergic to the diapers provided by the facility. Staff asked Mother to provide facility with a doctor's note so that they can order diapers to meet the needs of Child #1. During today's inspection, LPA observed a doctor's note in Child #1's file with a medical diagnosis. Director stated that since receiving the doctor's note, the facility has been supplying Child #1 with diapers to meet their needs.

LPA discussed diaper and toilet training policies and procedures with Director. LPA reviewed the Parent Handbook given to the authorized representative of each child in care. LPA was provided with a copy of the facility's Health Program Services Policies and Procedures and Parent Handbook.

This appears to be an isolated incident and staff took appropriate measures to address the child's needs, following policies, regulations and reporting requirements.

No deficiency cited during today's inspection.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2020
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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