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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243810088
Report Date: 05/02/2022
Date Signed: 05/02/2022 02:50:39 PM


Document Has Been Signed on 05/02/2022 02:50 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:CAMPUS PARK HEAD STARTFACILITY NUMBER:
243810088
ADMINISTRATOR:SUSAN CAMARGOFACILITY TYPE:
850
ADDRESS:1231 6TH STTELEPHONE:
(209) 381-5170
CITY:LIVINGSTONSTATE: CAZIP CODE:
95334
CAPACITY:49CENSUS: 26DATE:
05/02/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Susan Camargo - Master TeacherTIME COMPLETED:
03:00 PM
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On 5/2/22 Licensing Program Analysts (LPA) Joseph Pacheco and Priscilla Zamudio conducted an unannounced Case Management inspection. LPA met with Master Teacher (MT), Susan Camargo, toured the facility and a census was taken. An Unusual Incident report was submitted to the Fresno Child Care Regional Office regarding an incident that occurred on 3/24/22. On that day Child #1 was playing in the outside play area. Child #1 was running through the play area underneath the shade structure when they bumped into stationary play equipment with their body causing them to fall and hit their head on the concrete. MT was a few feet away from Child #1 at the time of the incident. Child #1 sustained a cut on their head due to the fall. Staff immediately provided first aid and was able to stop the bleeding. Child #1’s authorized representative’s were contacted and arrived at facility within 20 minutes of the incident. Child #1 conducted a virtual visit with their doctor as a precaution because an in-person visit was not available. Child #1’s doctor determined they were fine and no further treatment was needed. Child #1 missed one day of school as a precaution before returning. Child #1 has not had any further issues regarding this incident. There have been no further unusual incidents regarding children and the use of the outdoor play equipment.

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.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, no deficiencies are cited.

Exit interview conducted and report was reviewed with Master Teacher, Susan Camargo.

This report shall be made available to the public upon request. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:
DATE: 05/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/02/2022
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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