<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203801367
Report Date: 11/17/2022
Date Signed: 11/17/2022 12:26:15 PM

Document Has Been Signed on 11/17/2022 12:26 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:PIXIE LANDFACILITY NUMBER:
203801367
ADMINISTRATOR:JENKINS, TINAFACILITY TYPE:
850
ADDRESS:3290 SUNSETTELEPHONE:
(559) 673-2223
CITY:MADERASTATE: CAZIP CODE:
93637
CAPACITY: 50TOTAL ENROLLED CHILDREN: 50CENSUS: 13DATE:
11/17/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Tina JenkinsTIME COMPLETED:
01:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 11/17/22 Licensing Program Analyst (LPA) Caroline Harris conducted an unannounced case management inspection. LPA met with director, Tina Jenkins to discuss an incident which occurred on 9/13/22. A census was taken and the LPA interviewed staff and observed the area in which the incident occurred.

On 9/13/22, at approximately 4:38 pm, three children were left alone and unsupervised in the main lobby at the front of the facility, for approximately three minutes. The director, Tina Jenkins saw the children when coming to the front. The children's parent was notified and Ms. Jenkins reported the incident to Community Care Licensing.

When interviewing staff, the LPA was also made aware that when the incident happened, two assistants/aides were supervising approximately 9 children by themselves, and there was not a qualified teacher in the room.

California Code of Regulations, Title 22, Division 12, Chapter 1, are being cited on the attached LIC 9099D. An exit interview was conducted with Tina Jenkins. A plan of correction was discussed, and appeal rights were explained. A printed copy of this report as well as a printed copy of the appeal rights was provided to Ms. Jenkins at the conclusion of the visit.
LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Caroline Harris
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 11/17/2022 12:26 PM - It Cannot Be Edited


Created By: Caroline Harris On 11/17/2022 at 11:53 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: PIXIE LAND
FACILITY NUMBER: 203801367

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/17/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/01/2022
Section Cited
CCR
101216.1(b)

1
2
3
4
5
6
7
Teacher Qualifications and Duties. Prior to employment a teacher shall meet the specified requirements. This requirement was not met as evidenced by, during today's visit, the LPA was made aware of staff #1 and staff #2
1
2
3
4
5
6
7
The director agrees to conduct a training with her qualified teachers, addressing covering classrooms while at the same time staying within the requirements. A plan will be made on how the director will supervise this.
8
9
10
11
12
13
14
supervising 9 children by themselves. Neither staff have the required qualifications to meet the teacher requirements. This could pose a risk to children in care.
8
9
10
11
12
13
14
The training outline and sign in sheet will be sent to the LPA by 12/1/22.
Type B
11/17/2022
Section Cited
CCR101229(a)(1)

1
2
3
4
5
6
7
Care and Supervision. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time. This requirement was not met as evidenced by 3 children being left alone and
1
2
3
4
5
6
7
On 9/16/22 a staff training was conducted to address supervision and communication among the staff. A copy of the training and sign in was provided to the LPA. This citation was cleared.
8
9
10
11
12
13
14
unsupervised in the main lobby at the front of the facility, for approximately three minutes. This is a possible risk to the health, safety or personal rights of children in care.
8
9
10
11
12
13
14
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:Caroline Harris
LICENSING EVALUATOR SIGNATURE:
DATE: 11/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/17/2022


LIC809 (FAS) - (06/04)
Page: 2 of 2