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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203801886
Report Date: 08/10/2021
Date Signed: 08/10/2021 01:24:18 PM

Document Has Been Signed on 08/10/2021 01:24 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:COTTONWOOD CREEK HEAD START CENTERFACILITY NUMBER:
203801886
ADMINISTRATOR:CARUSO, IRENEFACILITY TYPE:
850
ADDRESS:2236 TOZARTELEPHONE:
(559) 664-1109
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY: 20TOTAL ENROLLED CHILDREN: 0CENSUS: 10DATE:
08/10/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Evelyn MoctezumaTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) conducted a case management inspection on this date. LPA met with site supervisor, Evelyn Moctezuma - Cruz. During today's inspection, LPA took a census, interviewed staff and received copies of Exposure Notices dated 8/4/21, 8/5/21 and 8/6/21.

LPA received an Unusual Incident Report regarding children with lice. From 8/4/21 to 8/6/21, more cases of lice was reported to Licensing. Parents did receive copies of Exposure Notices for the dates listed. These notices are kept in a binder, Parent Announcements, for parents to review. Parents were informed that children can return when nit free.

Facility staff conducts a daily check to verify child's health. Staff will check children for nits. Staff notified parents, provided a brochure for lice and the Exposure Notice. Facility did what was required for the health and safety of children in their care.

Per Title 22, Division 12, Chapter 3, 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: Michael Duarte
LICENSING EVALUATOR NAME: Cynthia Brannon
LICENSING EVALUATOR SIGNATURE: DATE: 08/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/10/2021
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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