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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153808307
Report Date: 06/17/2024
Date Signed: 06/17/2024 01:48:22 PM

Document Has Been Signed on 06/17/2024 01:48 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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:A GOOD TIME OUTFACILITY NUMBER:
153808307
ADMINISTRATOR/
DIRECTOR:
SHERMAN, MELANIE/KARENFACILITY TYPE:
850
ADDRESS:3400 CALLOWAY DRIVE, SUITE 501TELEPHONE:
(661) 410-8463
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY: 59TOTAL ENROLLED CHILDREN: 59CENSUS: 20DATE:
06/17/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Amy BennettTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On June 17, 2024 Licensing Program Analyst (LPA) Kari McWilliams conducted an unannounced case management visit and met with Director Amy Bennett. LPA McWilliams toured the facility and informed Director Bennett the purpose of todays inspection was due to an incident that occurred on June 3, 2024.

On June 3, 2024 Director Bennett reported that child #1 (C1) was sitting on the purple carpet with her class doing an exercise activity and a child stepped backwards and falling on C1. C1 was immediately comforted and ice was applied to C1 elbow. C1 was picked up by parent and taken to the emergency room at Mercy South West Hospital ex-rays confirmed C1 had a broken elbow. C1 had a following appointment at Valley Children's Hospital. C1 had surgery on June 4, 2024 and had pins put in their elbow. C1 returned to the center on June 10, 2024 and the only restriction is not getting wet. Director Bennett states that during the water play for their class, 2/3 year old preschool, C1 goes into the toddler classroom that goes to 36 months, child is 31 months. When the water play time is over C1 returns to their classroom. Director Bennett states that they are within ratio and the modification of time is approved by parents.

During todays inspection LPA observed the area that the incident occurred and watched the video of the incident. There was 22 children present and three staff members in the area when the incident occurred. LPA observed children dancing and moving with the music when the incident occurred. C1 is observed sitting and watching everyone dance and move with the music. LPA observed a child step backwards, not jumping or falling just stepping back and tripped over C1 and falling on top of C1 causing C1 arm to be injured. LPA observed that the purple carpet C1 was sitting on is a two inch padded gym mat.

LPA observed that the facility had appropriate supervision and the incident was observed and the child's needs were immediately met with first aid and parental contact. LPA informed Director Bennett best practice would be that while other children are up and dancing and moving that other children not be sitting in the area. If children do not want to participate in the activity have the child step aside and they can sit outside of the area where other children are dancing and playing or simply have the child stand up.
SUPERVISORS NAME: Luisa Gavoutian
LICENSING EVALUATOR NAME: Kari McWilliams
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: A GOOD TIME OUT
FACILITY NUMBER: 153808307
VISIT DATE: 06/17/2024
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Exit interview and report reviewed with Director Bennett.

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

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: Luisa Gavoutian
LICENSING EVALUATOR NAME: Kari McWilliams
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2024
LIC809 (FAS) - (06/04)
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