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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103801211
Report Date: 08/01/2023
Date Signed: 08/01/2023 11:42:23 AM

Document Has Been Signed on 08/01/2023 11:42 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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:SELMA MIGRANT HEAD STARTFACILITY NUMBER:
103801211
ADMINISTRATOR:GARCIA, GILBERTFACILITY TYPE:
850
ADDRESS:12898 S. FOWLER AVENUETELEPHONE:
(559) 896-4479
CITY:SELMASTATE: CAZIP CODE:
93662
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 18DATE:
08/01/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Gilbert Garcia TIME COMPLETED:
12:00 PM
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On 8/1/2023, Licensing Program Analysts (LPAs) Ruby Ocegueda and Valerie Mireles conducted an unannounced case management – unusual incident inspection. LPAs met with Center Director, toured the facility, and took a census. The purpose of today's inspection was to follow-up on an unusual incident that was reported to Community Care Licensing (CCL) on 7/21/2023. The Incident reported was regarding child #1 falling and hurting his/her elbow.

During today's inspection, LPAs interviewed staff regarding the unusual incident, reviewed file for child #1, reviewed and collected facility records, inspected the facility and area where child #1 fell. According to staff interview, it was reported that child #1 was in the circle time carpet area (of preschool classroom 1) when he/she tried to sit in a chair where a second child was already sitting. Child #1 fell back and hit his/ her elbow. Child initially reacted by laughing, however soon after began to complain and cry. Child did not allow staff to administer first aid on his/her elbow. Per interview, staff provided comfort to the child and monitored child until parent was called to pick up the child. Currently, child #1 is not attending the facility as the parent awaits results of medical examinations. Today, LPAs verified the sign in and out log for 7/21/2023 and observed that there were 15 children under the supervisor of two fully qualified teachers and one instructional aid. The carpet was inspected, and LPAs did not observe any tripping hazards. It is unknown if child did or did not obtain a fracture or other related injury at this time. Center Director will ensure that he obtains written directives from medical physician indicating any accommodations child might need upon his/her return to the facility and if they could not accommodate the child, they will inform the parent and obtain medical clearance before he/she returns to the facility.

Today, LPA’s determined that the facility met all reporting requirements as specified in Title 22 Regulation 101212 - Reporting Requirements. The incident is an isolated incident and not a result of lack of care and supervision.

No deficiencies cited in the areas observed today. This report is to be made available to the public upon request.LIC 9213 Notice of Site Visit to be posted for 30 days.
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2023
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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