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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103808850
Report Date: 01/19/2024
Date Signed: 01/19/2024 12:48:07 PM

Document Has Been Signed on 01/19/2024 12:48 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:STARTING BLOCKS CHILDREN'S ACADEMYFACILITY NUMBER:
103808850
ADMINISTRATOR:APRIL COXFACILITY TYPE:
850
ADDRESS:3315 E SIERRA MADRETELEPHONE:
(559) 227-7036
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY: 39TOTAL ENROLLED CHILDREN: 39CENSUS: 6DATE:
01/19/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:01 AM
MET WITH:Sandra GrahamTIME COMPLETED:
01:00 PM
NARRATIVE
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On 1/19/2024, Licensing Program Analyst (LPA) Stephanie Vega-Gonzalez conducted an unannounced Case Management inspection at facility. LPA met with Director, Sandra Graham who did not accompanied LPA during tour of facility both inside and outside. LPA explained the purpose of the inspection and took a census. LPA observed that Director and Staff #3 were both inside the preschool classroom 3 with a census of 6 children.

LPA Vega-Gonzalez was provided video footage on January 8, 2024 and a Unusual Incident Report that was not fully completed. LPA was informed that an incident had occurred on January 12, 2023 and that incident was never reported to Community Care Licensing. LPA Vega-Gonzalez reviewed Reporting Requirements with Director, Sandra Graham. LPA printed a copy of the LIC 624 Unusual Incident/Injury Report and reviewed document with Director, Sandra Graham.

Per California Code of Regulations, Title 22, Division 12, Chapter 1, a TYPE B deficiency is being cited on today’s date. Please view LIC809-D for deficiency.

Exit interview conducted with Director, Sandra Graham.
A copy of this report and Appeal Rights were provided and discussed with Director, Sandra Graham.
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: Stephanie Vega-Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/19/2024
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 01/19/2024 12:48 PM - It Cannot Be Edited


Created By: Stephanie Vega-Gonzalez On 01/19/2024 at 11:40 AM
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: STARTING BLOCKS CHILDREN'S ACADEMY
FACILITY NUMBER: 103808850

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/02/2024
Section Cited
CCR
101212(d)

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101212(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
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Director stated that they will review the Reporting Requirements regulations and write a statement on what they had learned. Director stated that statement will be given to the Department by POC due date of 02/02/2024.
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... (d)(2) below shall be submitted to the Department within seven days ...This requirement was not met as evidenced by: Incident that occurred on 01/12/2023 was not reported to the Department, which poses/posed a potential health, safety or personal rights risk to persons 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:Stephanie Vega-Gonzalez
LICENSING EVALUATOR SIGNATURE:
DATE: 01/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/19/2024


LIC809 (FAS) - (06/04)
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