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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203801227
Report Date: 11/19/2021
Date Signed: 11/19/2021 02:33:59 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:SIERRA VISTA MIGRANT HEAD STARTFACILITY NUMBER:
203801227
ADMINISTRATOR:LOPEZ, ELIZABETHFACILITY TYPE:
830
ADDRESS:917 E. OLIVE AVENUETELEPHONE:
(559) 675-9137
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY:24CENSUS: 0DATE:
11/19/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH:Lina BojorquezTIME COMPLETED:
03:15 PM
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On November 19, 2021, Licensing Program Analyst (LPA) Brannon met with Center Director, Lina Bojorquez.

During today's inspection, LPA toured the facility inside and outside. LPA took a census and interviewed staff, reviewed staff and children's files and received copies of sign in/out sheets.

On November 4, 2021, infant #1 sustained an injury and was seen by a physician. Per interview, infant #1 was running, tripped and fell. Infant #1 hit the right side of eyebrow. Staff #1 observed the incident but was not close enough to stop infant #1 from falling. Staff #1 stated that infant #1 was alone when the falling occurred. Staff #1 went to console infant #1 and assessed the injury. There was swelling. Staff #1 applied ice to the area of where the swelling took place. Staff #1 went inside to contact parent. Staff #1 informed parent, who decided to leave the infant at the facility. After nap time, staff #1 observed infant #1's eye was swollen. Parent was contacted. Grandmother came to pick up infant #1. Infant #1 returned to facility the next day. The eye remained swollen. Parent took the infant to be seen by a physician several days later. Per staff #1, parent stated that the physician said that the infant will be fine. The swelling will reside on its own.

Based upon interview findings, staff provided supervision. Staff remained in ratio with 2 staff outside with 4 infants in care. Staff met the infant's needs and parent was contacted in a timely manner,

No deficiency was cited during today's inspection.
A COPY OF THIS REPORT IS TO REMAIN IN THE FACILITY FOR PUBLIC REVIEW.
THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 388-3635
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021
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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