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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543810043
Report Date: 10/26/2022
Date Signed: 10/27/2022 07:45:55 PM


Document Has Been Signed on 10/27/2022 07:45 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:VUSD-CRESTWOOD ELEMENTARY SCHOOL E.L.C.FACILITY NUMBER:
543810043
ADMINISTRATOR:AMY SULLIVANFACILITY TYPE:
850
ADDRESS:3001 W WHITENDALETELEPHONE:
(559) 730-7564
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY:96CENSUS: 39DATE:
10/26/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Lisa SalazarTIME COMPLETED:
02:45 PM
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On 10/26/2022, Licensing Program Analyst (LPA) Theresa Marquez conducted a Case Management inspection and met with Preschool Technician Lisa Salazar. The purpose of the inspection is in regards to a self reported incident that occurred at the preschool on 9/30/2022.

On 9/30/2022, a child was entering his classroom at about 2:30 PM. Staff, Wendy Vargas noticed the child was having a seizure and contacted the school nurse, Alisa Campos, who came to the classroom. The nurse administered to the child his prescribed medication. Program Manager (PM), Susan Mc Fadden called 911 and teacher, Lauren Duck contacted the child's mother. Emergency personnel arrived and PM McFadden went in the ambulance with the child and met the mother at the hospital emergency room.

On 10/3/2022, Program Director Leticia Trevino and Lisa Salazar conducted a home visit and the child was doing well. The child returned to school on 10/4/2022.

LPA Marquez discussed with Salazar the requirements of an Incidental Medical Services (IMS) plan. LPA Marquez reviewed the Individualized Health Care Plan developed by the school RN that is on file for the child. LPA Marquez provided to Salazar an informational IMS guidelines document. Salazar stated she will discussed the development of an IMS plan for the preschool with the Director Leticia Trevino.

Per California Code of Regulations, Title 22, Division 12, Chapter 1, no deficiencies cited today.
SUPERVISOR'S NAME: Luisa GavoutianTELEPHONE: (559) 650-7879
LICENSING EVALUATOR NAME: Theresa MarquezTELEPHONE: (559) 341-7123
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2022
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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