103801211-8-28-2023-57-CC-ROCA-CV5V34-20230828160406

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103801211
Report Date: 08/28/2023
Date Signed: 08/28/2023 04:04:13 PM

Document Has Been Signed on 08/28/2023 04:04 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:	SELMA MIGRANT HEAD START		FACILITY NUMBER:	103801211
ADMINISTRATOR:	GARCIA, GILBERT		FACILITY TYPE:	850
ADDRESS:	12898 S. FOWLER AVENUE		TELEPHONE:	(559) 896-4479
CITY:	SELMA	STATE: CA	ZIP CODE:	93662
CAPACITY: 45	TOTAL ENROLLED CHILDREN: 45	CENSUS: 11	DATE:	08/28/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	02:40 PM
MET WITH:	Carmen Sedano		TIME COMPLETED:	04:15 PM

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On 8/28/2023, Licensing Program Analysts (LPAs) Ruby Ocegueda and Claribel Soto conducted an unannounced case management inspection for the purpose of addressing a self-reported Unusual Incident to the Department. Upon arrival, LPA’s notified Head Teacher Carmen Cedeno the reason for the inspection. LPA’s toured the facility and took a census.

On 8/8/2023, facility representative contacted the Fresno Regional Office (FRO) to report that a child (child #1) had been accidentally left in the enclosed play yard without any staff supervision. Today, head teacher Carmen Cedeno confirmed that on 8/8/2023 at approximately 10:06 AM, the staff on duty counted 13 children before transitioning back to the classroom. The three staff on duty (staff #1, staff #2, staff #3) did not realize that after counting the children, child #1 went back and hid. Approximately three minutes after the staff and children transitioned into the classroom, child #1 walked himself/herself to the classroom where staff #4 then realized that child #1 was accidentally left in the play yard.

Per reporting staff, staff notified the parents of the incident on the same day and LPA collected records confirming that the parent was notified. Child #1 was reportedly unhurt and did not appear to be in emotional distress. Today, head teacher Carmen Cedano discussed updated procedures to help avoid any absence of supervision in the future. Updated procedures included inspecting the play yard before the children return into the classroom. Staff continue to count the children as they enter the classroom. Per head teacher Cedeno, staff has been trained on these new procedures and were trained on active supervision. Today, LPA notified facility representatives that an informal meeting at the FRO would be arranged to further discuss this incident.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D). Today a 500.00 civil penalty was assessed.

SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023

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
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: SELMA MIGRANT HEAD START	FACILITY NUMBER: 103801211
	VISIT DATE: 08/28/2023

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Appeal rights were provided to head teacher Cedeno today and LPA Ocegueda reviewed this report.

Upon receipt of a Type A violation, facility staff 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 LIC 9224 was given to head teacher Cedeno.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/28/2023 04:04 PM - It Cannot Be Edited

Created By: Ruby Ocegueda On 08/28/2023 at 03:29 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: SELMA MIGRANT HEAD START	FACILITY NUMBER: 103801211
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/28/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/29/2023 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	(a)The licensee shall provide care and supervision as necessary to meet the children's needs.(1) No child(ren) shall be left without the supervision of a teacher at any time...Supervision shall include visual observation. This requirement was not met as evidenced by: interview and record review.	1 2 3 4 5 6 7	Today, head teacher Cedeno indicated that the staff had since received training on active supervision. Head teacher stated that the facility staff walk the play yard to inspect it and ensure no children are left outside. Proof of training agenda with staff signatures will be submitted to the
	8 9 10 11 12 13 14	Interviews confirmed that child #1 was left without supervision in the play yard on 8/8/2023 for about 3 minutes. This posed/poses an immediate risk to the health, safety and/or personal rights to the children in care. A $500.00 immediate civil penalty was assessed today.	8 9 10 11 12 13 14	Department by POC date 8/29/2023. An informal meeting will be scheduled at the Department to further address the incident.
	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:

Susie Fanning

LICENSING EVALUATOR NAME:

Ruby Ocegueda

LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023

LIC809 (FAS) - (06/04)

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