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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100404087
Report Date: 10/25/2024
Date Signed: 10/25/2024 11:50:37 AM

Document Has Been Signed on 10/25/2024 11:50 AM - 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: 33DATE:
10/25/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:20 AM
MET WITH:Site Supervisor Neng ThaoTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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On 10/25/2024 Licensing Program Analyst (LPA) Xona Xayavong arrived at the facility to conduct a Case Management-Incident inspection. LPA met with Site Supervisor Neng Thao. LPA explained the reason for the inspection was to follow up on an unusual incident report. LPA Xayavong toured the facility and a census was taken.

On 10/14/2024, the Fresno Regional Office received an unusual incident report stating that on 10/11/2024 at between 8-8:30 am, during breakfast at the school cafeteria, S2 witnessed S3 grabbed C1 on the face and squished it aggressively with their hand. S3 then made C1 apologize to another child.

During today’s inspection, LPA Xayavong conducted staff interview. Based upon the staff interviews, LPA determine there was a violation of Personal Right as S2 confirmed that S3 aggressively squished C1’s face. LPA confirmed S3 is no longer at the facility.



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

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: 10/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2024
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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Document Has Been Signed on 10/25/2024 11:50 AM - It Cannot Be Edited


Created By: Xona Xayavong On 10/25/2024 at 11:25 AM
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: 10/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/25/2024
Section Cited
CCR
101223(a)(3)

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To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of punitive nature…
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Site Supervisor stated a training will be conducted to address children in care personal rights and reporting requirement. A sign in sheet for attendees will be submitted to licensing by 11/08/2024.
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Based upon staff interviews, staff aggressively grabbed the child’s face and the incident was not address immediately. Due to lack of personal rights this poses as a potential risk to the health and safety of the 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:Kari McWilliams
LICENSING EVALUATOR NAME:Xona Xayavong
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2024


LIC809 (FAS) - (06/04)
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