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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100404087
Report Date: 09/19/2024
Date Signed: 09/19/2024 04:30:27 PM

Document Has Been Signed on 09/19/2024 04:30 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 CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:FUSD-KING CHILD DEVELOPMENT CENTERFACILITY NUMBER:
100404087
ADMINISTRATOR/
DIRECTOR:		MATHIES, DEANNAFACILITY TYPE:
850
ADDRESS:1001 E. FLORENCETELEPHONE:
(559) 457-3690
CITY:FRESNOSTATE: CAZIP CODE:
93706
CAPACITY: 53TOTAL ENROLLED CHILDREN: 53CENSUS: 29DATE:
09/19/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:40 PM
MET WITH:Neng ThaoTIME VISIT/
INSPECTION COMPLETED:
04:30 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 09/20/2024 Licensing Program Analysts (LPAs) Xona Xayavong and Ka Vang arrived at the facility to conduct a Case Management-Incident inspection. LPAs met with Site Supervisor Neng Thao. LPAs explained the reason for the inspection was to follow up on an unusual incident report. LPAs Xayavong and Vang toured the facility and a census was taken.

On 09/18/2024, the Fresno Regional Office received an unusual incident report stating that on 09/13/2024 at approximately 10:35 AM, after recess and in the Toddler Classroom, S3 brought the children inside the classroom to wash their hands. Per staff interviews, all the children and the staff were inside the classroom and the door was closed. While the children were washing their hand, S2 conducted another head count and noticed there was only 7 children in the classroom out of 8. S2 then opened the door again and child (C1) was outside crying. Per staff interview, C1 was left outside without adult supervisor.

During today’s inspection, LPAs Xayavong and Vang conducted record review and interviews with staff. Based upon staff interviews, LPAs determine there was lack of supervision as staff did not realize there was a child missing after entering the classroom from recess.



Per California Code of Regulations, Title 22, Division 12, Chapter 1, a Type A deficiency is being cited on the attached LIC 809D.

Continue on 809-C
SUPERVISORS NAME: Kari McWilliams
LICENSING EVALUATOR NAME: Xona Xayavong
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2024
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: FUSD-KING CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 100404087
VISIT DATE: 09/19/2024
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
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 Acknowledgement of Receipt of Licensing Reports was given to Site Supervisor Neng Thao. Per Site Supervisor Neng Thao a completed signed copy of the LIC 9224 will be placed in each child's file.

An exit interview conducted with Site Supervisor Neng Thao. A copy of this report and Appeal Rights were provided and discussed with Site Supervisor Neng Thao. A Notice of Site Visit Form was posted to parent's board and must remain posted for 30 days.
SUPERVISORS NAME: Kari McWilliams
LICENSING EVALUATOR NAME: Xona Xayavong
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 09/19/2024 04:30 PM - It Cannot Be Edited


Created By: Xona Xayavong On 09/19/2024 at 04:00 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: FUSD-KING CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 100404087

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/19/2024
Section Cited
CCR
101229(a)(1)

1
2
3
4
5
6
7
No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
1
2
3
4
5
6
7
Site Supervisor conducted a staff training regarding expectations of supervision with a sign in sheet of all attendees on 09/17/2024. Site Supervisor posted a sign in and sign out sheet before entering and exiting the classroom to remind staff to conduct head count of children in care.
8
9
10
11
12
13
14
Based upon staff interviews, Staff entered the classroom without a child and realized there was a child missing the after door was closed. Due to lack of supervision this poses as an immediate risk to the health and safety of the children in care.
8
9
10
11
12
13
14
Licensee is to provide a written proof indicating as to how supervision will be maintain at all time.

1
2
3
4
5
6
7
1
2
3
4
5
6
7

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:Kari McWilliams
LICENSING EVALUATOR NAME:Xona Xayavong
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2024


LIC809 (FAS) - (06/04)
Page: 3 of 3