<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543801059
Report Date: 06/24/2022
Date Signed: 06/24/2022 02:27:34 PM


Document Has Been Signed on 06/24/2022 02:27 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:RICHGROVE DISTRICT STATE PRESCHOOLFACILITY NUMBER:
543801059
ADMINISTRATOR:ROSIQUE, ERIKAFACILITY TYPE:
850
ADDRESS:20812 GROVE DRIVETELEPHONE:
(661) 725-2424
CITY:RICHGROVESTATE: CAZIP CODE:
93261
CAPACITY:155CENSUS: 7DATE:
06/24/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Erika RosiqueTIME COMPLETED:
02:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
A case management inspection was conducted today by Licensing Program Analyst (LPA) Jose Penate. LPA met with Site Supervisor, Erika Rosique to discuss incident which occurred on 06/08/2022. A complete file review was conducted prior to visit. LPA toured facility inside and outside. A census was taken.

On today’s visit LPA interviewed Staff that were present when the incident occurred. A series of questions were asked regarding the incident and they were discussed with Teachers. LPA verified that all procedures were followed and that the child was immediately assisted. Child has returned back to facility and it has been documented by primary physician to return to the center.

Per California Code of Regulations Title 22, Division 12, no deficiency cited during today's visit.

Exit interview conducted with the Site Supervisor, Erika Rosique.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Jose PenateTELEPHONE: (559) 341-5860
LICENSING EVALUATOR SIGNATURE:
DATE: 06/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/24/2022
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 1