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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103808268
Report Date: 06/16/2022
Date Signed: 06/16/2022 12:03:41 PM


Document Has Been Signed on 06/16/2022 12:03 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:HANSEL & GRETEL III WISHONFACILITY NUMBER:
103808268
ADMINISTRATOR:CHAO YANGFACILITY TYPE:
830
ADDRESS:2045 N. WISHONTELEPHONE:
(559) 227-5436
CITY:FRESNOSTATE: CAZIP CODE:
93704
CAPACITY:13CENSUS: 6DATE:
06/16/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Chao YangTIME COMPLETED:
12:15 PM
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On 06/16/2022, Licensing Program Analyst (LPA) Jeovanna Yanez conducted an unannounced case management inspection. LPA toured the facility and a census was taken. LPA met with Director, Chao Yang. The purpose today's inspection was to discuss an incident that occurred on 4/11/22, in which Parent had reported that Child #1 was diagnosed with a sprained right shoulder. This incident was reported to the Fresno Community Care Licensing Office on 4/11/22 by Director.

Director stated on 4/11/22, Parent called in the morning to report that Child #1 was diagnosed with a sprained right shoulder. Director stated Parent believed this injury must have occurred sometime on 4/8/22 at the facility. Director stated on there were four (4) staff, including herself, and four (4) children present on the date parent alleged Child #1 was injured. Director stated Child #1 appeared fine during the day, and Parent did not report any concerns when Child #1 was dropped off or picked up on that date. Director stated child was picked up around 5:00 PM on 4/8/22 and did not appear injured or hurt when Parent picked them up. Director conducted interviews with Staff #1, Staff #2, and Staff #3 whom all stated they did not see Child #1 get injured, and provided their statements about how Child #1 was observed on 4/8/22. Director requested medical documentation from Parent, which was received on 4/14/22. Director stated she consulted with Program Director, Rita Johnson, to provide a training for staff, which was completed on 4/12/22 discussing different topics such as: Building Strong Relationships with Families, Title 22 Regulations Subchapter 02 - Infant Care Centers, Hansel & Gretel Inc. Employee Handbook pgs. 54-63, and Documentation examples. Director stated Child #1 did not return to the facility, but was transferred to another Hansel & Gretel location (#100404622) and returned to care a week after the incident, 4/18/22. Director stated child is reportedly doing fine now.

LPA reviewed pertinent documentation at the facility. LPA observed the sleeping area for infants and found no hazards present. Based on the information obtained, this appears to be an isolated incident and staff took appropriate measures to address this incident, following proper policies and procedures and no regulations were violated. (continued on 809-c)
SUPERVISOR'S NAME: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Jeovanna YanezTELEPHONE: (559) 341-5629
LICENSING EVALUATOR SIGNATURE:
DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/16/2022
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-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: HANSEL & GRETEL III WISHON
FACILITY NUMBER: 103808268
VISIT DATE: 06/16/2022
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Per California Code of Regulations Title 22, Division 12, no deficiency cited during today's visit. Exit interview conducted with the Director, Chao Yang.

A Notice of Site Visit Form was posted to parent's board and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Jeovanna YanezTELEPHONE: (559) 341-5629
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
LIC809 (FAS) - (06/04)
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