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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153810187
Report Date: 04/11/2023
Date Signed: 04/11/2023 03:02:01 PM

Document Has Been Signed on 04/11/2023 03:02 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:ESCUELITA HERNANDEZ LITTLE SCHOOLFACILITY NUMBER:
153810187
ADMINISTRATOR:HERNANDEZ,RAQUELFACILITY TYPE:
850
ADDRESS:909 CASTRO LANETELEPHONE:
(661) 422-5437
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY: 26TOTAL ENROLLED CHILDREN: 26CENSUS: 18DATE:
04/11/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Raquel Hernandez - Director TIME COMPLETED:
03:15 PM
NARRATIVE
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On 4/11/2023, Licensing Program Analyst (LPA) Jessika Thompson conducted an unannounced case management inspection. LPA met with Administrator Raquel Hernandez to discuss an incident that occurred on 3/7/23. LPA toured the facility, took a census, interviewed staff, and observed the area in which the incident occurred.
LPA interviewed Staff #1 who stated that Child #1 made a small hole in the preschool classroom wall using a pencil sometime in January of 2023. Staff #1 stated that a bookshelf was placed in front of the hole immediately thereafter to restrict access to the area and to prevent further damage. Staff #2 stated that on 3/7/2023, the bookshelf was removed and the hole was filled with wood filler paste. It was reported that subsequently on 3/7/2023, Staff #2 observed Child #1 with their back turned toward a wall, so she walked closer to child in an effort to see what the child was doing. Staff #2 stated that when the child turned towards her, she noticed a small amount of wood filler residue around the child's mouth. According to Staff #2, she then realized that the child must have ingested the wood filler. Staff #2 stated that Director Hernandez was notified, and Director Hernandez responded by immediately assessing the child. Director Hernandez stated that she immediately called poison control, who advised staff to monitor the child, also indicating that common side effects associated to ingesting the aforementioned substance include upset stomach and diarrhea. According to Director Hernandez, the child did not show any signs of illness or injury following the incident, and the child returned to care the next day.

During interviews, Staff #1 and Staff #2 both indicated that the incident occurred during a transitional period of the day. Staff #2 who was directly attending child in the classroom stated that she did not observe the child eat the substance or fiddle with the wall, although she was in close proximity to the child. LPA has determined that although adequate ratios were in place when the incident occurred, a lack of proper supervision resulted in the child ingesting the wood filler paste.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D). Licensee was provided a copy of appeal rights. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Administrator Raquel Hernandez.
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Jessika Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2023
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 04/11/2023 03:02 PM - It Cannot Be Edited


Created By: Jessika Thompson On 04/11/2023 at 02:18 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: ESCUELITA HERNANDEZ LITTLE SCHOOL
FACILITY NUMBER: 153810187

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/28/2023
Section Cited
CCR
101229(a)(1)

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Care and Supervision. The licensee shall provide care and supervision as necessary to meet the children's needs. No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation.
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Administrator Hernandez state that she will host a training pertaining to regulatory compliance and licensing regulation 101229(a)(1); an agenda, copy of training materials, and list of attendees is to be submitted to the Fresno Community Care Licensing (CCL) office by 04/28/23.
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This requirement was not met, as evidenced by information obtained by LPA (see LIC809 for further details). This poses a potential risk to the health, safety, or 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:Jessika Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2023


LIC809 (FAS) - (06/04)
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