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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 500306377
Report Date: 12/05/2019
Date Signed: 12/05/2019 03:01:22 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:CCCDS PATTERSON CHILD DEVELOPMENT CENTERFACILITY NUMBER:
500306377
ADMINISTRATOR:AYALA, SANDRAFACILITY TYPE:
850
ADDRESS:456 EUREKATELEPHONE:
(209) 892-8130
CITY:PATTERSONSTATE: CAZIP CODE:
95363
CAPACITY:120CENSUS: 36DATE:
12/05/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Sandra OrtegaTIME COMPLETED:
03:30 PM
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LPA Claudia Henley conducted a case management visit. LPA at facility due to an incident which occurred on 11/19/19 at approximately 10:00 a.m. I was met by Sandra Ortega, Head Teacher.

LPA interviewed with Sandra Ortega regarding the incident. Teacher Ortega stated she was the witness to the incident. Child #1 was playing around the climbing structure with other children and Child #1 tripped on her own feet and fell. Child #1 hit a two foot high small sized playground structure pole, sustaining a cut to her face under the eye area. Child #1 was given first aid and parent was called. The parent took child to the ER and child had sutures applied. At the time of the incident there was two staff and eight children.

BASED UPON INFORMATION THAT WAS OBTAINED FROM THE FACILITY STAFF, IT IS DETERMINED THAT THERE WERE NO VIOLATIONS OF CCL REGULATIONS. NO FURTHER ACTION IS REQUIRED AT THIS TIME.
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Claudia HenleyTELEPHONE: (559) 341-5776
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2019
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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