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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543808911
Report Date: 05/06/2022
Date Signed: 05/06/2022 02:25:58 PM


Document Has Been Signed on 05/06/2022 02:25 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:FARMERSVILLE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
543808911
ADMINISTRATOR:GARCIA, MARCELAFACILITY TYPE:
850
ADDRESS:455 N. LINNEL AVENUETELEPHONE:
(559) 747-3155
CITY:FARMERSVILLESTATE: CAZIP CODE:
93223
CAPACITY:96CENSUS: 48DATE:
05/06/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Marcela GarciaTIME COMPLETED:
02:30 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
On 05/06/2022, Licensing Program Analyst (LPA) Robert Gutierrez met with Site Supervisor, Marcela Garcia for an unannounced case management incident inspection. LPA toured the facility and a census was taken. The purpose of today's inspection was to address an unusual incident, reported to the Fresno Community Care Licensing (CCL) office. This incident occurred at the facility in playground on 04/26/2022 and was reported to the CCL office on 04/27/2022 after 5:00 PM.

This incident involved a day-care child who fell and hit his head on the cement in the playground. While running in the playground sometime between 12:15 PM – 12:40 PM Child #1 (C1) fell onto the cement. Child #2 (C2) running after C1 fell on top him/her. Staff #1 (S1) was outside alone supervising eight children in care. S1 observed the incident take place and took C1 into the classroom. While in the classroom, S1 informed Staff #2 (S2) that C1 fell but, did not disclose that they fell on their head nor that a C2 fell on top of him/her. Being brought into the classroom, C1 mentioned his/her ear hurt. S2 accessed C1 for injuries pertaining to his/her ear but did not see any swelling or redness. S2 offered C1 a clean towel to clean his/her face. C1 then walked to his cot as it was a transition to nap. After a couple of minutes on the cot, C1 started to cry cupping his ear. S1 then gave a C1 an ice pack and the child fell asleep. C1 later woke up from the nap and for the remainder of the day kept to him/herself.

It was at pick up at around 4:00 PM Ms. Garcia noticed a bump on the side of C1 head. It was at that moment the legal guardian of C1 was informed an injury occurred at the facility. C1 was taken home, but still complained about his/her head hurting. C1 was later taken to the hospital and was diagnosed with a head injury. C1 has been released from the hospital but still has not returned back to care.

Continued on 809-C
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Robert GutierrezTELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:
DATE: 05/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2022
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 4


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: FARMERSVILLE CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 543808911
VISIT DATE: 05/06/2022
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
26
27
28
29
30
31
32
With the incident taking place, Program Director Hanadi Rousan scheduled an all staff meeting on 04/29/2022. This meeting addressed topics such as reporting requirements to CCL and legal guardians of children in care, staff supervision and safety in child care settings. Another meeting regarding similar topics shall be scheduled later in the future. As a result of the incident, S1 was let go from the facility.

LPA informed Ms. Garcia this incident shall be brought to upper management for review and a meeting could be scheduled.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiencies are being cited: (see next page, 809 D) Licensee was provided a copy of their appeal rights.

Upon receipt of a Type A violation, 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. A copy of the Fact Sheet - Child Care Parent Notification Requirements and a copy of LIC 9224 was given to licensee.

SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Robert GutierrezTELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 05/06/2022 02:25 PM - It Cannot Be Edited

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: FARMERSVILLE CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 543808911

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/06/2022
Section Cited

1
2
3
4
5
6
7
The licensee shall immediately notify the child's authorized representative if the child becomes ill or sustains an injury more serious than a minor cut or scratch. The licensee shall obtain specific instructions from the authorized representative regarding action to be taken.
8
9
10
11
12
13
14
This requirement is not met as evidenced by interviews conducted during today’s inspection. LPA was informed, while at the center C1 sustained a head injury on 04/26/2022 between 12:15 PM – 12:40 PM. However, the legal guardian of C1 was not informed of the injury until pick up at around 4:00 PM. This poses as an immediate risk to the health, safety, or personal rights of children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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: Robert GutierrezTELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:
DATE: 05/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4


Document Has Been Signed on 05/06/2022 02:25 PM - It Cannot Be Edited

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: FARMERSVILLE CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 543808911

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/06/2022
Section Cited

1
2
3
4
5
6
7
Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.
8
9
10
11
12
13
14
This requirement is not met as evidenced by interviews conducted during today’s inspection. LPA was informed on 04/26/2022 between 12:15 PM and 12:40 PM C1 sustained a head injury at the facility. This incident was not reported to the CCL office until 04/27/2022 after 5:00 PM. This poses as a potential risk to the health, safety, or personal rights of children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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: Robert GutierrezTELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:
DATE: 05/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4