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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503604207
Report Date: 10/23/2019
Date Signed: 10/23/2019 11:38:59 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:BOER SCHOOL HEAD START CENTERFACILITY NUMBER:
503604207
ADMINISTRATOR:DUVAL PATTYFACILITY TYPE:
850
ADDRESS:4801 GOLD VALLEY ROADTELEPHONE:
(209) 545-8592
CITY:SALIDASTATE: CAZIP CODE:
95368
CAPACITY:20CENSUS: 14DATE:
10/23/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Julia ReyesTIME COMPLETED:
12:00 PM
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LPA Claudia Henley conducted a case management visit today due to an incident which occurred on 10/9/19. LPA was met by three staff. There were 14 children present. Interviewed with two staff.

On 10/9/19 at approximately 10:15 a.m., while on the playground climbing structure, Child #1 jumped off to the ground from a 34 inch climbing structure platform. Child #1 landed on his two feet flat onto the ground, sustaining a slightly sprained ankle. Interview with the teacher who witnessed the incident stated that Child #1 was warned not to jump off the platform from that particular area, but ignored staff and jumped anyway. Staff was not able to intervene in time and keep child from jumping. At the time of the incident there was two staff and 16 children.

Since the incident, staff have placed red tape on the climbing/monkey bar and advised all children that if they jump from the structure they can only jump from the red zone area and not on the platform itself.

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.

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: 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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