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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103808435
Report Date: 12/11/2023
Date Signed: 12/11/2023 10:55:22 AM

Document Has Been Signed on 12/11/2023 10:55 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-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:FUSD-NORSEMANFACILITY NUMBER:
103808435
ADMINISTRATOR:MADDEN, KATHERINEFACILITY TYPE:
850
ADDRESS:4636 E. WELDONTELEPHONE:
(559) 457-3690
CITY:FRESNOSTATE: CAZIP CODE:
93703
CAPACITY: 22TOTAL ENROLLED CHILDREN: 22CENSUS: 0DATE:
12/11/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Cher HangTIME COMPLETED:
11:30 AM
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On 12/11/2023 Licensing Program Analyst (LPA) Anita Tristan, conducted a Case Management- Incident Inspection. The Unusual Incident took place on 10/13/2023 regarding Personal Rights of an injury- Unknown Origin that was reported to Fresno Regional Office, by Health and Safety Supervisor Charlotte Miranda. LPA met with Lead Teacher, Cher Hang and one other staff member. LPA explained the reason of the visit. There were no children present at the facility during the time of the inspection; the facility is currently having teacher-parent conferences and class ended at 10:00am. LPA toured the facility inside and outside playground.

During today’s inspection, LPA interviewed staff, and observed that the playground was clean and did not have any sticks or loose branches lying around or on the ground. LPA did notice that the playground area is full of wood chips.

This was an isolated event and the facility took appropriate measures to address the incident, followed appropriate policies, regulations, and reporting requirements.



Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, no deficiencies are being cited.

An exit interview was conducted and a report was provided to Lead Teacher Cher Hang.

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

SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Anita Tristan
LICENSING EVALUATOR SIGNATURE: DATE: 12/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2023
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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