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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203801195
Report Date: 10/15/2019
Date Signed: 10/15/2019 01:23:06 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: 34DATE:
10/15/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Martha Bravo - DirectorTIME COMPLETED:
01:30 PM
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On 10/15/2019 at 12:30pm, Licensing Program Analyst (LPA), Joseph Pacheco arrived at the facility to conduct an unannounced Case Management inspection to discuss an incident report submitted to Community care Licensing regarding an incident that occurred in the facility on 8/26/2019. The Director stated that on the day of the incident the class was transitioning from outside play to coming inside to eat lunch. Child #1 was running in the classroom when they slipped, fell and hit their head on the corner of the sink right outside of the bathroom in Classroom A. The result of the accident was a bump on the forehead. Child #1 was treated with an ice pack and the mother was notified immediately. Mother came and picked up Child #1 from the facility approximately 10 minutes after being notified. Mother took Child #1 to their doctor for treatment. Director stated that Child #1 did not receive any further medical treatment. LPA discussed supervision at the time of the incident and it was determined that appropriate supervision was in place. Staff will continue to remind children not to run inside the classroom. LPA inspected the area where the incident took place and did not observe any safety hazards or areas of concern.

This appears to be an isolated incident and staff took appropriate measures to address Child #1's injury, following appropriate 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: 10/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019
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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