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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 500317738
Report Date: 10/04/2023
Date Signed: 10/04/2023 01:01:28 PM

Document Has Been Signed on 10/04/2023 01:01 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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:CA STATE UNIVERSITY STANISLAUS CDCFACILITY NUMBER:
500317738
ADMINISTRATOR:SMITH, STEPHANIFACILITY TYPE:
850
ADDRESS:ONE UNIVERSITY CIRCLETELEPHONE:
(209) 667-3036
CITY:TURLOCKSTATE: CAZIP CODE:
95382
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 10DATE:
10/04/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Stephani SmithTIME COMPLETED:
01:20 PM
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On 10/04/2023, Licensing Program Analysts (LPA), Anita Tristan met with Director Stephani Smith for an unannounced Case Management- Inspection. LPA toured the facility and a census was taken. An Unusual Incident Report was submitted to the Fresno Community Care Licensing Office (CCL) regarding an incident that occurred on 9/14/2023 where child #1 fell off the structure, near the ladder/climbing area, which resulted in getting tangled in the bottom of the ladder and hitting her face on the ground/wood chips.

Staff has procedures in place when children are playing on the play structure staff is to be within arm’s reach of the structure. Staff #1 was within arm’s reach and was kneeling next to the structure. As the child slipped off the structure staff #1 was not able to prevent the child from falling.

The director advised all staff to continue to follow the outdoor supervision policy that is already in place in and added a new procedure of adding another adult in the proximity when a child is near the chain ladder.

This was an isolated event and the facility took appropriate measures to address the incident, followed appropriate policies, regulations, and reporting requirements.



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

An exit interview was conducted and a report was provided to Director, Stephani Smith.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Anita Tristan
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2023
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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