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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203801369
Report Date: 08/23/2024
Date Signed: 08/23/2024 12:36:19 PM

Document Has Been Signed on 08/23/2024 12:36 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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:PIXIE LANDFACILITY NUMBER:
203801369
ADMINISTRATOR/
DIRECTOR:
JENKINS, TINAFACILITY TYPE:
830
ADDRESS:3290 SUNSETTELEPHONE:
(559) 673-2223
CITY:MADERASTATE: CAZIP CODE:
93637
CAPACITY: 22TOTAL ENROLLED CHILDREN: 12CENSUS: 11DATE:
08/23/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:50 AM
MET WITH:Tina JenkinsTIME VISIT/
INSPECTION COMPLETED:
12:50 PM
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On 08/23/2024, a Case Management inspection was conducted by Licensing Program Analysts (LPAs) Julio Rodriguez and Miguel Herrera. LPAs met with Director Tina Jenkins to discuss an incident report submitted to Community Care Licensing regarding an incident that occurred in the facility on 08/02/2024. The Director stated that on the date of the incident, Child #1 fell and struck the corner of the fish tank located in the toddler room of the facility. Child #1 received a cut on his forehead. First aid was then administered and parents were immediately notified. Parent picked up child and took him to Valley Children's hospital for medical attention. Child #1 was medically treated and required stitches for his injury. Child #1 was later medically discharged. Child returned to care the following working day on 08/05/2024. LPAs discussed supervision at the time of the incident and it was determined that appropriate supervision was in place. Staff will continue to remind children not to run inside the classroom. Director Jenkins stated that the incident occurred during the morning when Child #1 was dropped off and was making his way to the infant room via the toddler room. The toddler room is bypassed in order to get to the infant room, the rooms are separated by a door. LPA inspected the area where the incident took place and did not observe any tripping hazards or areas of concern. LPA advised licensee to consider applying adhesive foam to the corner of the fish tank in order to avoid any future accidents.

This appears to be an isolated incident and staff took appropriate measures to address the child’s injury, following appropriate policies, regulations, and reporting requirements.

Per California Code of Regulations, Title 22, Division 12, Chapter 1, there is no deficiency cited during today's inspection. A notice of site visit was given and must remain posted for 30 days. Exit interview was conducted with Director, Tina Jenkins. This report is to be made available to the public upon request. LIC 9213 Notice of Site Visit to be posted for 30 days.

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Miguel Herrera
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2024
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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