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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103808427
Report Date: 03/04/2024
Date Signed: 03/04/2024 04:34:53 PM

Document Has Been Signed on 03/04/2024 04:34 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:FEOC EARLY HEAD START CHILD DEVELOPMENT CENTERFACILITY NUMBER:
103808427
ADMINISTRATOR:MADRIGAL-CONTRERAS, MARIAFACILITY TYPE:
850
ADDRESS:1441 E. DIVISADERO AVENUETELEPHONE:
(559) 263-1205
CITY:FRESNOSTATE: CAZIP CODE:
93721
CAPACITY: 24TOTAL ENROLLED CHILDREN: 15CENSUS: 10DATE:
03/04/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:01 PM
MET WITH:Maria MadrigalTIME COMPLETED:
04:45 PM
NARRATIVE
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On 03/04/2023, Licensing Program Analyst (LPA) Miguel Herrera conducted an unannounced case management inspection at the facility. LPA met with Site Supervisor, Maria Madrigal who accompanied LPA during a tour of the facility both inside and outside. LPA explained the purpose for the inspection and a census was taken. During the case management visit, facility observations were completed, facility records were reviewed, and interviews were conducted with staff.

Based on interviews and records review, LPA Herrera confirmed that child #1 was left unsupervised in the play yard while staff #1 was inside the classroom. Through interviews LPA Herrera observed that staff #1 had various lack of supervision incidents occur under their care. During staff #1's file review LPA Herrera observed various incident reports relating to lack of supervision. Furthermore, during interviews LPA Herrera noted two other incidents that occurred under staff #1’s care that related to lack of supervision. Based on observation and records review LPA Herrera confirmed that the facility failed to report two confirmed incidents to the Fresno Regional Office either by telephone or fax within 24 hours of the occurrence. 1. Child was left unsupervised in the playground while staff #1 was inside the classroom with two other children. 2. Due to lack of supervision child shattered toilet lid while staff #1 was occupied changing diapers.

Per California Code of Regulations, Title 22, Division 12, Chapter 1, this deficiency is being cited on the attached LIC 809D.

An exit interview conducted with Site Supervisor, Maria Madrigal. A copy of this report and Appeal Rights were provided and discussed with Maria Madrigal. A Notice of Site Visit Form was posted to parent's board and must remain posted for 30 days.
SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Miguel Herrera
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2024
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 03/04/2024 04:34 PM - It Cannot Be Edited


Created By: Miguel Herrera On 03/04/2024 at 03:25 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: FEOC EARLY HEAD START CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 103808427

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/11/2024
Section Cited
CCR
101212(d)(1)(C)

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101212(d)(1)(C) Reporting Requirements(d)Upon the occurrence, during the operation of the child care 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......
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Site Supervisor stated that they will call in the unsual incident and submit an unsual incident report to CCL by POC due date. Furthermore, Site Supervisor stated that she will ensure all incident reports are documented and reported to Fresno RO by following up with the incidents reports with management.
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This requirement was not met as evidenced by: Based on that the facility did not report incidents to CCL as stated in LIC809. This poses a potential risk to the health, safety, or personal rights of children.
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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:Miguel Herrera
LICENSING EVALUATOR SIGNATURE:
DATE: 03/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/04/2024


LIC809 (FAS) - (06/04)
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