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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543810135
Report Date: 12/15/2021
Date Signed: 12/16/2021 08:43:21 AM

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:RAGGEDY ANN & ANDYFACILITY NUMBER:
543810135
ADMINISTRATOR:NAVARRO, MARIA CFACILITY TYPE:
850
ADDRESS:2015 S ENCINA STTELEPHONE:
5597380111
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY:25CENSUS: 11DATE:
12/15/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Maria NavarroTIME COMPLETED:
03:15 PM
NARRATIVE
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On 12/15/2021, Licensing Program Analyst (LPA) Theresa Marquez conducted a Case Management inspection and met with Director Maria Navarro. The purpose of this inspection is in regards to an incident that occurred at the center on 12/6/2021.

On 12/6/2021, a child suffered an asthma attack. The child was administered his prescribed inhaler by facility staff, per paramedics directions. Director Navarro and staff Georgina Gonzalez notified the child's mother, the grandmother, and Emergency personnel (911). Navarro and the child were transported by 911 ambulance to the hospital emergency room. The child was admitted to the hospital for additional testing and blood work.

Although the facility has consent forms signed by the child's authorized representative, the facility does not have an approved Incidental Medical Services (IMS) plan on file with Community Care Licensing (CCL). The Director was advised to submit an IMS plan to the Fresno CCL office for review within 30 days or by 1/15/2022.

Per Chapter 1, Division 12, Title 22 of the California Code of Regulations, the following deficiency was found: (see LIC809-D). The facility failed to notified CCL that a similar incident occurred with this same child on 10/4/2021.

Director Navarro was provided a copy of this Evaluation report, the Appeal Rights and the Notice of Site visit which is to be posted for 30 days.

SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Theresa MarquezTELEPHONE: (559) 341-7123
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
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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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: RAGGEDY ANN & ANDY
FACILITY NUMBER: 543810135
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/31/2021
Section Cited

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REPORTING REQUIREMENTS 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 Dept. by telephone or fax within the Dept. next working day & during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Dept. within 7 days following the occurrence of such event.
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This requirement was not met as evidence by record review: Facility failed to report an unusual incident of a child experiencing an asthma attack and required medical attention. This poses a potential risk to the health, safety or personal rights of children in care.
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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: Theresa MarquezTELEPHONE: (559) 341-7123
LICENSING EVALUATOR SIGNATURE:
DATE: 12/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/15/2021
LIC809 (FAS) - (06/04)
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