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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 500308706
Report Date: 03/12/2020
Date Signed: 03/12/2020 03:40:08 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:EVERETT CHILD DEVELOPMENT CENTERSFACILITY NUMBER:
500308706
ADMINISTRATOR:NUNES, HEIDIFACILITY TYPE:
850
ADDRESS:1530 MT VERNON DRTELEPHONE:
(209) 576-4121
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY:90CENSUS: 53DATE:
03/12/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Kimbra DraperTIME COMPLETED:
02:30 PM
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LPA Claudia Henley conducted a case management visit today due to an incident that occurred on 2/26/2020 at approximately 11:30 a.m. out on the playground. Interviewed with staff member who was present by the playground structure when a child was hurt on a piece of the playground structure equipment. Interview with the staff stated that the child hit his head on the metal echo speaker which is attached to the structure. The child sustained a cut injury to his head and was seen by a physician. Child did not require any sutures and is back at the child care center. There were three staff and 20 children supervising the children at the time of the incident.

BASED UPON INFORMATION THAT WAS OBTAINED FROM THE FACILITY STAFF, IT IS DETERMINED THAT THERE WERE NO VIOLATIONS OF CCL REGULATION. NO FURTHER ACTION IS REQUIRED AT THIS TIME.

Site Visit Notice posted. Exit interview was conducted.
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Claudia HenleyTELEPHONE: (559) 341-5776
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020
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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