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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503602075
Report Date: 10/23/2019
Date Signed: 10/23/2019 11:55:03 AM

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 TURLOCK CHILD DEVELOPMENT CENTERFACILITY NUMBER:
503602075
ADMINISTRATOR:FELIX, CALLETANAFACILITY TYPE:
830
ADDRESS:400 NORTH KILROY RDTELEPHONE:
(209) 669-6374
CITY:TURLOCKSTATE: CAZIP CODE:
95380
CAPACITY:36CENSUS: 9DATE:
10/23/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Calletana FelixTIME COMPLETED:
12:30 PM
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 Licensing Program Analyst (LPA) Brannon conducted a case management inspection. LPA met with site supervisor, Calletana Felix. During today's visit, LPA interviewed staff #1, #2 and #3. On October 8, 2019, infant #1 received an injury to left eye area.
Staff #1, #2 and #3 were on the infant play yard. Infant #1, who is one years old, was seen walking through the infant climbing structure. Staff #1 was by the sand box with infants. Staff #2 was an estimated 3 feet away from infant #1. Staff #3 was 7 feet away from infant #1. Sign in/out sheets indicate there were 8 infants with 3 staff members. Staff #2 observed infant #1 walking in the climbing structure. She turned her head to help another infant. She heard infant #1 cry and saw infant #1 laying face down on the rubber pour form that is used as cushioning around the low height infant climbing structure. Staff #2 picked up infant #, put on gloves and used a Klenex to clean the area. Staff #1 arrived to assist and took infant #1 into the classroom. Staff #1 put on gloves, cleaned area and applied ice. Site supervisor, Calletana Felix was notified. Parents were called and arrived shortly. Infant #1 was taken to ER. Infant #1 returned to facility the following day. Per site supervisor, a follow-up visit was conducted with primary physician on Friday, October 11, 2019. Staff will continue to stay within ratio and provide supervision as required. LPA inspected the area where the incident took place and did not observe any safety hazards or areas of concern. LPA observed infant #1 during today's inspection. LPA observed a very light pink area of injury. Infant #1 was concentrating on eating lunch.
This appears to be an isolated incident and staff took appropriate measures to address the child's injury, following appropriate policies, regulations and reporting requirements.
Per California Code of Regulations, Title 22, Chapter 1, no deficiency was cited during today's visit. Exit interview conducted with site supervisor, Calletana Felix.
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2019
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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