203808549-11-3-2021-04-CC-CBRN-C8ES2Q-20211103132956

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 203808549
Report Date: 11/03/2021
Date Signed: 11/03/2021 01:30:01 PM

Document Has Been Signed on 11/03/2021 01:30 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:	MIS ANGELITOS MIGRANT HEAD START CENTER		FACILITY NUMBER:	203808549
ADMINISTRATOR:	LUGO, LOURDES		FACILITY TYPE:	850
ADDRESS:	75 E. ADELL STREET		TELEPHONE:	(559) 673-2252
CITY:	MADERA	STATE: CA	ZIP CODE:	93638
CAPACITY: 52	TOTAL ENROLLED CHILDREN: 0	CENSUS: 29	DATE:	11/03/2021
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	07:45 AM
MET WITH:	Rosalva Romero		TIME COMPLETED:	02:00 PM

NARRATIVE

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On November 3, 2021 Licensing Program Analyst (LPA) Brannon, conducted an unannounced case management inspection. LPA met with Center Director, Rosalva Romero; took a census, reviewed a child's file, conducted an interview and toured the facility indoors and outdoors. Days and hours of operation are Monday through Friday, 8:00 AM to 4:00 PM. Director verified facility phone number is (559)673-2564.

LPA received an unusual incident report for an incident that occurred on 9/2/21. Per interview, staff reviews outside rules before going outside to the play area. Child #1 was playing outside at or near 10:45 AM. Staff #1 was standing, facing towards child #1 and witnessed the following: Child #1 was playing with a ball on the cement area, next to the chain link double-door gates. Child #1`stepped on the ball, lost her balance and fell down onto the cement walk way, hitting forehead and causing a bruise to form. Staff #1 was on the cement walk way, but not close enough to prevent child #1 from falling. Staff #1 assessed child and placed an ice pack on child #1's forehead. Child's parent was called. Child #1 was taken to the emergency room to be seen by a physician. Child #1 received a head injury and was released by physician to be observed at home for one day. Over the counter medication was prescribed by physician, if there was any pain. Staff #1 called and spoke with parent. Staff #1 was informed that the child was fine and would be returning to facility the next day. Due to the holiday, Labor Day, child #1 returned on 9/7/21.

Facility staff provided first aid to child #1 and adhered to Title 22, section 101212 - Reporting Requirements. Staff followed their program's protocol and notified parent of injury to their child and reported this incident to Licensing in a timely manner.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited. Licensee was provided a copy of their appeal rights. Exit interview conducted and report was reviewed with center director, Rosalva Romero.

This report shall be made available to the public upon request. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Cynthia Brannon
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021

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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