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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503808604
Report Date: 05/17/2019
Date Signed: 05/17/2019 01:13:39 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:MUNCY EARLY HEAD STARTFACILITY NUMBER:
503808604
ADMINISTRATOR:HOTCHKISS, JEWELEEFACILITY TYPE:
830
ADDRESS:2410 JANNA AVENUETELEPHONE:
(209) 238-0572
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY:48CENSUS: 0DATE:
05/17/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Shawnda PomboTIME COMPLETED:
01:45 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Brannon and Slaughter conducted a case management visit. During today's visit, LPAs met with Jewelee Hotchkiss, Director II and Shawnda Pombo, Master Teacher. During today's visit, LPAs conducted interviews, reviewed staff and children's files.

Interviews and written statement reflect the following actions of staff #1 towards day care children. The three incidents occurred on 4/16/19 with three different day care children.

Incident #1: Child # 3 was playing in the dramatic play area. Child #3 was wearing a dress. Interviews reflect staff #1 roughly removed dress from child and made an inappropriate statement.

Incident #2: Interviews reflect staff #1 was observed to physically force child #2 to sit on a chair and flick the child's forehead.

Incident #3: Interviews reflect staff #1 lift child #1 into the air by one arm and walked child approximately 10 feet, and sit the child on a chair. Staff stated that the child is not a baby and needs to listen. Child #1 attempted to get up and staff #1 grabbed child #1 by both arms and sat her back down with force. Child #1 was taken to emergency on 4/16/19. No treatment was required but cautioned to monitor child for bruising or injury.

Licensee placed staff #1 on administrative leave on the date of the incidents. Licensee notified parents of the incidents. CONTINUED ON FOLLOWING PAGE
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: MUNCY EARLY HEAD START
FACILITY NUMBER: 503808604
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/17/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/24/2019
Section Cited
CCR
101223(a)(3)
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Personal Rights. To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.
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Per Director II, Jewelee Hotchkiss, staff shall receive personal rights training by 5/24/19. A copy of training agenda and attendance will be sent to the Fresno Community Care Licensing office by 5/24/19.
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This requirement was not met as evidenced by staff #1 removing a play dress from child #3 and making an inappropriate comment, utilizing force to make a child sit down in a chair, and by lifting a child by one arm in the air, which caused a parent to take the child to be seen by a physician. This is an immediate health, safety and personal rights risk to day care children.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: MUNCY EARLY HEAD START
FACILITY NUMBER: 503808604
VISIT DATE: 05/17/2019
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Staff #1's actions towards the children were punitive in nature.

Type A deficiency was cited. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

Per California Code of Regulations Title 22, Division 12, this deficiency to be cited. Exit interview conducted with Master Teacher, Shawnde Pombo. POC/Appeal Rights were given and discussed. A copy of this report needs to be placed in facility file for public review. A Notice of Site Visit was posted on parent board.

A COPY OF THIS REPORT IS TO REMAIN IN THE FACILITY FOR PUBLIC REVIEW.
THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3