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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100406903
Report Date: 11/15/2024
Date Signed: 11/15/2024 02:12:39 PM

Document Has Been Signed on 11/15/2024 02:12 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:FUSD-BALDERASFACILITY NUMBER:
100406903
ADMINISTRATOR/
DIRECTOR:		BECKWITH, KIMFACILITY TYPE:
850
ADDRESS:4625 E. FLORENCETELEPHONE:
(559) 457-3690
CITY:FRESNOSTATE: CAZIP CODE:
93725
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 7DATE:
11/15/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Jua Cha, TeacherTIME VISIT/
INSPECTION COMPLETED:
02:20 PM
NARRATIVE
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On 11/15/2024, Licensing Program Analyst (LPA) Priscilla Zamudio conducted an unannounced case management inspection. LPA met with Teacher, Jua Cha to discuss an incident which occurred on 11/7/24. A census was also taken. There were 7 children present. LPA interviewed staff and reviewed pertinent information.

Based on information gathered and interviews conducted, upon class dismissal on 11/7/2024, an adult who spoke limited English, identified himself as grandfather of Child#1. Staff released Child#1 with the adult without verifying proper identification and they left the school. Parent of Child#1 arrived for pick up but was informed by staff that the grandfather had already picked up Child#1. The parent confirmed that it was not the grandfather of Child#1 who picked up. Staff were later informed that the grandfather was there to pick up Child#2 and left with Child#1 by mistake. The grandfather returned to the school with Child#1 within 15-20 minutes after being picked up.

Staff reported that on 11/13/24, they received training on supervision of children, reporting requirements, and Learning Genie sign-in & out procedures.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiency is cited (see LIC809D).

Upon receipt of a Type A violation, licensees 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 Center Supervisor.

Teacher Jua Cha was provided a copy of appeal rights. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Teacher.
SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Priscilla Zamudio
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2024
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 11/15/2024 02:12 PM - It Cannot Be Edited


Created By: Priscilla Zamudio On 11/15/2024 at 01:32 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-BALDERAS
FACILITY NUMBER: 100406903

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/15/2024
Section Cited
CCR
101229(a)(1)

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CCR 101229(a)(1) Care and Supervision. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1).

This requirement is not met as evidenced by:
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Facility has taken steps to remedy the situation by providing training to all staff.

Deficiency cleared.
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 Based on interviews, the licensee did not comply with the section cited above. On 11/7/24, Child #1 was released to an unauthorized and unrelated adult, being without staff supervision for approximately 20 minutes. This poses an immediate health, safety, or personal rights risk to persons 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:Cynthia Brannon
LICENSING EVALUATOR NAME:Priscilla Zamudio
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2024


LIC809 (FAS) - (06/04)
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