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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243808255
Report Date: 01/31/2023
Date Signed: 01/31/2023 01:28:10 PM


Document Has Been Signed on 01/31/2023 01:28 PM - It Cannot Be Edited

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:PIONEER HEAD STARTFACILITY NUMBER:
243808255
ADMINISTRATOR:HERNANDEZ, MELISSAFACILITY TYPE:
850
ADDRESS:1500 MEREDITH AVENUETELEPHONE:
(209) 854-1744
CITY:GUSTINESTATE: CAZIP CODE:
95322
CAPACITY:28CENSUS: 11DATE:
01/31/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Melissa McDanielsTIME COMPLETED:
01:35 PM
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On 1/31/2023, Licensing Program Analyst (LPA) Ruby Ocegueda conducted an unannounced case management – unusual incident inspection. LPA met with Site Supervisor Melissa McDaniels, toured the facility and took a census. The purpose of today's inspection was to follow-up on an unusual incident that was reported to Community Care Licensing (CCL) on 9/14/2022. The Incident reported was regarding child (child #1) that fell off the walking ramp while walking inside from the play yard and caused a broken elbow.

During today's inspection, LPA interviewed staff regarding the unusual incident and inspected facility. Site Supervisor stated that the facility reminds the children to avoid “bunching up” when walking in or out of the facility to avoid falls. Site supervisor also stated a work order was submitted requesting to permanently block off the openings on the railing to reduce the risk of a child falling through and onto the pavement. Copy of the work order was obtained. Currently a large planter and other wood play structure is blocking the area at the highest point of the ramp to help reduce the risk of children falling through.

This Facility met all reporting requirements as specified in Title 22 Regulation 101212 - Reporting Requirements. The incident is an isolated incident and not a result of lack of care and supervision.

No deficiencies cited in the areas observed today.

This report is to be made available to the public upon request.
LIC 9213 Notice of Site Visit to be posted for 30 days.
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ruby OceguedaTELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:
DATE: 01/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2023
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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