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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503607701
Report Date: 08/27/2019
Date Signed: 08/27/2019 01:03:03 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:CHILDREN'S CRISIS CENTER-GUARDIAN HOUSEFACILITY NUMBER:
503607701
ADMINISTRATOR:GARCIA, COLLEENFACILITY TYPE:
850
ADDRESS:246 WEST F STREETTELEPHONE:
(209) 577-0138
CITY:OAKDALESTATE: CAZIP CODE:
95361
CAPACITY:26CENSUS: 15DATE:
08/27/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Maria SidaTIME COMPLETED:
01:30 PM
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LPA Claudia Henley conducted a case management visit due to an incident which occurred on 8/12/19. Child #1 had a seizure while out on the playground area on 8/12/19 at approximately 11:55 a.m. Interviewed with Site Supervisor Sida regarding the incident. Reviewed the children's file. Ms. Sida stated that the child has not returned to the center as of this date due to continued illness. LPA advised Site Supervisor that once the child returns to the center, a proposed medical plan of operation when child is at the center needs to be submitted to the department.

No deficiencies were cited during the inspection today.

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

DATE: 08/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2019
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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