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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103808401
Report Date: 09/20/2021
Date Signed: 09/20/2021 03:19:15 PM

Document Has Been Signed on 09/20/2021 03:19 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:FRESNO EOC SEQUOIA HEAD STARTFACILITY NUMBER:
103808401
ADMINISTRATOR:HICKINGBOTTOM, RUTHFACILITY TYPE:
850
ADDRESS:2121 N. VAN NESS BLVD.TELEPHONE:
(559) 263-1200
CITY:FRESNOSTATE: CAZIP CODE:
93704
CAPACITY: 45TOTAL ENROLLED CHILDREN: 0CENSUS: 22DATE:
09/20/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Ruth HickingbottomTIME COMPLETED:
03:35 PM
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On 9/20/2021, Licensing Program Analyst (LPA) Ocegueda conducted a Case Management Report for the purpose of addressing Reporting Requirements. Today, LPA met with Director Hickingbottom and informed her of the reason for the inspection. LPA took a census and toured the facility indoors and outdoors.

On 8/24/2021, facility staff reported to Community Care Licensing (CCL) that child #1 sustained an injury/red mark on his/her face. The injury/red mark was determined to be caused by the child sleeping on the plastic mesh cot’s frame during nap time on Friday 8/20/2021. The facility places white sheets over the cots during nap time, however during nap time, the cot frame can become exposed during the natural movement of the children. The cots were inspected and were in clean and in good repair. Although the injury was slight at approximately an hour before pick up time, it did get worse after pick up. It was discovered through record review and interview that multiple facility staff did notice the red mark on child #1’s face after nap time and noticed that it had not dissipated 1.5 hours after nap time was over. Per staff, it is common for children to wake up up with slight red marks on their cheeks from sleeping over their arm or from resting their face on top of the frame, however the marks quickly dissipate. Child #1's red mark was observed 1.5 hour after nap time was over and was observed to be dark red (per time stamped photo provided to LPA). Although the facility did inform CCL of the child's injury in a timely manner, they did not inform the parent at pick up time. Since the parent was not aware there was a red mark and because the child #1 was wearing a mask after pick up, the parent could not monitor the child's cheek throughout the evening and by the time it was discovered by the parent, the mark/injury had grown more red and started to scab similar to a a burn mark. The parent discovered the injury later in the evening at approximately 8:00 PM and informed the facility staff immediately via text message.

Today, Licensing Program Analyst (LPA) Ocegueda reviewed reporting requirements with Director Hickingbottom in detail and recommended that the facility check and monitor the children's faces and any exposed skin after wake up time. Report continued on 809-C.

SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2021
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 09/20/2021 03:19 PM - It Cannot Be Edited


Created By: Ruby Ocegueda On 09/20/2021 at 01:36 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: FRESNO EOC SEQUOIA HEAD START
FACILITY NUMBER: 103808401

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/20/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/18/2021
Section Cited
CCR
101212(f)

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Reporting Requirements
(f)The items specified in (d)(1)(A) through (H) above shall also be reported to the child's authorized representative. This requirement was not met as evidenced by: Record review and interview. Today, Director confirmed that staff did not inform parent at pick up that child #1 had an
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Director stated that she and staff would monitor children for any possible markings or injuries that developed during school or after nap time and inform parent of any sustained injury as required. A training will be conducted with staff on reporting requirements, agenda and staff signature page will be submitted to CCL by POC date: 10/18/2021.
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injury/mark on his/her face that was caused by child #1 placing his/her face on the cot's frame during nap time. Staff acknowledged that the injury/mark was not there before nap time and several staff noticed it afterwards. This poses a potential risk to the health, safety and 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:Michael Duarte
LICENSING EVALUATOR NAME:Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2021


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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: FRESNO EOC SEQUOIA HEAD START
FACILITY NUMBER: 103808401
VISIT DATE: 09/20/2021
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Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D) Licensee was provided a copy of their appeal rights.

Exit interview was conducted with Director Ruth Hickingbottom.

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: Michael Duarte
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2021
LIC809 (FAS) - (06/04)
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