503608903-12-15-2021-04-CC-LGAN-C9QPLC-20211215102431

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 503608903
Report Date: 12/15/2021
Date Signed: 12/15/2021 10:24:34 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:	KEYES HEAD START		FACILITY NUMBER:	503608903
ADMINISTRATOR:	MCCORMICK, BRANDY		FACILITY TYPE:	850
ADDRESS:	4621 NUNES ROAD		TELEPHONE:	(209) 656-2388
CITY:	TURLOCK	STATE: CA	ZIP CODE:	95382
CAPACITY:	40	CENSUS: 12	DATE:	12/15/2021
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Director Brandy McCormick		TIME COMPLETED:	10:35 AM

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On 12/15/2021, Licensing Program Analyst (LPA) Luisa Gavoutian conducted an unannounced case management inspection. LPA met with Director Brandy McCormick, toured the facility, and took a census. The purpose of the inspection was to discuss an incident that had occurred at the facility on 11/30/2021.

Director stated that on 11/30/2021 at approximately 9:55 a.m., Child 1 was climbing on the outside play structure when Child 1 missed one of the bars on the way down and fell off. Child 1 was climbing down the white curved bar area. Child 1 bumped their head on one of the bars and sustained a cut on the back of their head. Staff 1, who witnessed the incident but was unable to stop it from happening, immediately administered first aid by cleaning the wound and applying an ice pack and contacted Child 1’s parent. Child 1 was taken to urgent care and the wound was closed with two staples. Child 1 was allowed to return to care the following day. LPA discussed supervision at the time of the incident, and it was determined that appropriate supervision was in place and facility was following their active supervision plan. There were ten children and two staff present outside at the time of the incident, with Staff 1 zoned by the play structure. LPA inspected the play area where the incident took place and did not observe any safety hazards or areas of concern. LPA observed the play structure did not have manufacturer’s stickers showing age recommendation for the structure. Director stated the play structure has been in place for 18 years and she shall contact the school district for the manufacturer’s information in order to obtain the stickers, which will then be placed on the structure. Staff will continue to remain vigilant to children climbing on the play structure.

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.

An exit interview was conducted with Director Brandy McCormick. No deficiencies cited during today’s inspection.

A copy of this report to be made available to the public upon request. LIC 9213 Notice of Site Visit to be posted for 30 days.

SUPERVISOR'S NAME: Alice Juarez	TELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa Gavoutian	TELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

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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