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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153808616
Report Date: 09/11/2023
Date Signed: 09/11/2023 04:19:55 PM

Document Has Been Signed on 09/11/2023 04:19 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:TIERRA SERENA CHILD DEVELOPMENT CENTERFACILITY NUMBER:
153808616
ADMINISTRATOR:LORENA PALOMOFACILITY TYPE:
830
ADDRESS:17213 CENTRAL VALLEY HWYTELEPHONE:
(805) 544-4355
CITY:SHAFTERSTATE: CAZIP CODE:
93263
CAPACITY: 17TOTAL ENROLLED CHILDREN: 17CENSUS: 0DATE:
09/11/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Lorraine PalomoTIME COMPLETED:
04:45 PM
NARRATIVE
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On 09/11/2023, Licensing Program Analyst (LPA) Ocegueda conducted a case management inspection in order to address an unusual incident that was reported to the Department on 9/5/2023. LPA met with Center Director Lorraine Palomo today and informed her of the reason for the inspection. LPA toured the facility, and a census was taken. There were no children in care at the time of this inspection due to early release.

On 9/5/2023, the facility representative contacted the Department to report that an infant (infant #1) fell from the changing table located in the infant room while staff #1 was changing infant #1. Today, LPA inspected the area, interviewed staff #1 and interviewed Center Director. Interviews revealed that staff #1 was holding infant #1 and lost grip of infant after he/she was done changing infant’s diaper. The infant fell to the ground hitting his/her right side of head and body. Per interview, staff #1 began working with infants in August of 2023. Records revealed that staff #1 is a fully qualified teacher and has infant educational units. No medical records were available as parents reported that they did not take infant #1 to seek medical evaluation.

LPA reviewed personal rights of children in care, reminding Site Supervisor that staff must be able to properly hold and physically manage infants and children in order to provide a safe and healthful environment.

Per Title 22, Division 12, Chapter 1 of the California Code of Regulations, the following deficiency is being cited (see 809-D). Appeal Rights were provided.

An exit interview was conducted with Center Director Lorraine Palomo.

Upon receipt of a Type A violation, facility staff shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. A copy of LIC 9224 was given to Center Director Palomo.



LIC 9213 Notice of Site Visit must be posted for 30 days.
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE: DATE: 09/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2023
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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Document Has Been Signed on 09/11/2023 04:19 PM - It Cannot Be Edited


Created By: Ruby Ocegueda On 09/11/2023 at 03:36 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: TIERRA SERENA CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 153808616

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/12/2023
Section Cited
CCR
101223(a)(2)

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Personal Rights.(a)The licensee shall ensure that each child is accorded the following personal rights:(2)To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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Today Center Director stated she would submit a written plan of action that reviews personal rights regulations and the requirement to properly and safely hold and physically manage infants. Written plan of action will be submitted to the Department by POC date 9/12/2023.
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This requirement was not met as evidenced by: record review and interviews. Staff #1 lost grip of infant #1 after a diaper change, causing infant #1 to hit/her head and body on the ground. This poses an immediate risk to the health, safety and personal rights of children 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:Susie Fanning
LICENSING EVALUATOR NAME:Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE:
DATE: 09/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/11/2023


LIC809 (FAS) - (06/04)
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