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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103808814
Report Date: 10/27/2021
Date Signed: 10/27/2021 11:20:59 AM

Document Has Been Signed on 10/27/2021 11:20 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:ST. AGNES CHILD DEVELOPMENT CENTERFACILITY NUMBER:
103808814
ADMINISTRATOR:PRICE, MARYELLENFACILITY TYPE:
850
ADDRESS:1255 E. HERNDON AVE.TELEPHONE:
(559) 450-3545
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY: 143TOTAL ENROLLED CHILDREN: 143CENSUS: 37DATE:
10/27/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Maryellen PriceTIME COMPLETED:
11:45 AM
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 Licensing Program Analyst (LPA) Brannon met with director, Maryellen Price. LPA conducted a case management inspection due to receiving an unusual incident that occurred on 9/30/21. During today's visit, LPA toured the facility, inside and outside, took a census, reviewed files and interviewed staff.
Director adhered to Title 22 regulations, 101212 - Reporting Requirements and sent in an unusual incident report after calling Fresno Regional office to report the incident. The unusual incident report provided information of a child biting another child. The children were on the wooden climbing structure to observe a helicopter taking off from the roof of nearby hospital. As the children were climbing down from structure, a child bit another child. Interviews reflect that child #1 bit child #2. The bite was unprovoked and unexpected. The bite caused redness, was deep and broke the skin. Teacher #1, took the crying child #2, provided comfort and assessed the bite injury. The bite was washed with soap and water. An ice pack was applied. Staff #1 called child #2's father, who arrived at or around 15 minutes. Child #2 was seen by a physician, who prescribe antibiotic. Child #1's parents were contacted and several director/parent conferences has taken place. Child #1 has been assessed by a medical professional. Certified behavior specialist and behavior technician work with child #1 for four hours, four days a week at center and within the child's home setting. Staff reported that there has been a significant improvement with child #1's understanding activities and what is occurring at the preschool. LPA verified that there were 11 children with two staff providing supervision to children in the outside play area on the date of the biting incident. Staff took appropriate actions and followed protocol to ensure that they are providing a safe and healthy environment to the children in care.
Per California Code of Regulations Title 22, Division 12, no deficiency cited during today's inspection. Exit interview conducted with director, Maryellen Price. A copy of this report needs to be placed in facility file for public review. A Notice of Site Visit will be posted on parent board for 30 days.
To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Cynthia Brannon
LICENSING EVALUATOR SIGNATURE: DATE: 10/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2021
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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