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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543801073
Report Date: 01/14/2020
Date Signed: 01/14/2020 05:46:37 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:CUTLER CHILD DEVELOPMENT CENTER #2FACILITY NUMBER:
543801073
ADMINISTRATOR:SYLVIA AVILAFACILITY TYPE:
850
ADDRESS:12890 SCHOOL AVENUETELEPHONE:
(559) 528-1834
CITY:CUTLERSTATE: CAZIP CODE:
93615
CAPACITY:100CENSUS: 56DATE:
01/14/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Sylvia AvilaTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Diana Martinez conducted an unannounced case management inspection to address a reporting requirement concern that was identified during the complaint investigation on 11/19/19. LPA met with Center Supervisor Sylvia Avila, toured the facility, and obtained census.

Facility procedures for reporting incidents were discussed. Staff report incidents as witnessed and are instructed when writing the reports to be accurate, descriptive, and to avoid omitting significant details. Going forward in situations where lead witnesses/staff are unable to clearly compose details into written form due to English being their second language, staff will write original draft in their first language and supervisor will transcribe original draft onto Children’s Accident/Illness Report Form. Original draft is to be attached to Children’s Accident/Illness Report Form.

Per California Code of Regulations, Title 22, Division 12, Chapter 1, no deficiencies cited.

An exit interview conducted with Center Supervisor Sylvia Avila, and a copy of this report is provided and discussed. A Notice of Site Visit Form is posted on parent's board and must remain posted for 30 days.
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Diana D MartinezTELEPHONE: (559) 341-4670
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2020
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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