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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103808399
Report Date: 02/27/2024
Date Signed: 02/27/2024 03:05:47 PM

Document Has Been Signed on 02/27/2024 03:05 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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:CLOVIS COMMUNITY COLLEGE C.D. LAB SCHOOLFACILITY NUMBER:
103808399
ADMINISTRATOR:EMILY KEMBLEFACILITY TYPE:
850
ADDRESS:10309 N WILLOW AVETELEPHONE:
(559) 325-5240
CITY:FRESNOSTATE: CAZIP CODE:
93730
CAPACITY: 80TOTAL ENROLLED CHILDREN: 31CENSUS: 20DATE:
02/27/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:41 PM
MET WITH:Emily KembleTIME COMPLETED:
03:30 PM
NARRATIVE
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On February 27,2024, Licensing Program Analyst (LPA) Yesenia Fierro conducted an unannounced Case Management Inspection. LPA met with Director, Emily Kemble. LPA Fierro toured the facility and took a census. The purpose of today’s inspection was to discuss an incident that was reported to Community Care Licensing (CCL) on February 15, 2024, but occurred on February 13, 2024, pertaining to a child slipping and falling hitting the right side of her head, resulting in a concussion without the loss of consciousness. (Refer to LIC 812 dated 2/15/2025 Author Licensing Program Analyst (LPA) Anita Tristan). Director was advised that any type of head injury should be reported immediately to the Department due to the potential after affects it can have on a child.

Based on the information obtained by file review and interview with the Director, Emily Kemble. The facility failed to inform the Department of the incident that occurred within the allotted time frame.



Based on Unusual Incident Report received via email from Director Emily Kemble on February 15, 2024 and interview with the Director, Emily Kemble. The facility failed to report the incident, which is a violation of Title 22, Reporting Requirements.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D)

Exit interview conducted and report was reviewed with Director Emily Kemble.



Notice of site visit was given and must remain posted for 30 days.

A copy of this report and appeal rights were provided.

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Yesenia Fierro
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2024
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 02/27/2024 03:05 PM - It Cannot Be Edited


Created By: Yesenia Fierro On 02/27/2024 at 02:43 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: CLOVIS COMMUNITY COLLEGE C.D. LAB SCHOOL
FACILITY NUMBER: 103808399

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/12/2024
Section Cited
CCR
101212(d)(1)(B)

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(d) Upon the occurrence, during the operation of the childcare center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.
(1) Events reported shall include the following:
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Director will watch the Child Care Reporting Requirements video on the CCL website Child Care Center Operators – California Child Care Licensing – Resources for Parents and Providers (childcarevideos.org) and submit a written plan on what actions will be implemented to follow reporting requirements.
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(B) Any injury to any child that requires medical treatment.
Director Emily Kemble reported an incident on 2/15/2024 that occurred on 2/13/2024 by phone. Director failed to report the incident to the Department by telephone within the Department’s next workday of the occurrence of the incident.
This requirement was not met as evidenced by record review when LPA received a copy of the Unusual Incident Report and Director self-admitting that the incident occurred on 2/13/2024 and was not reporting to the Department until 2/15/2024. Which exceeded the allotted time frame.
This poses a potential risk to the health, safety, or personal rights of 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:Juvenal Moctezuma
LICENSING EVALUATOR NAME:Yesenia Fierro
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2024


LIC809 (FAS) - (06/04)
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