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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203810160
Report Date: 02/26/2024
Date Signed: 02/26/2024 01:46:38 PM

Document Has Been Signed on 02/26/2024 01:46 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:LA VINA STATE PRESCHOOLFACILITY NUMBER:
203810160
ADMINISTRATOR:MOISES PEREZFACILITY TYPE:
850
ADDRESS:8594 ROAD 23TELEPHONE:
(559) 675-4490
CITY:MADERASTATE: CAZIP CODE:
93637
CAPACITY: 15TOTAL ENROLLED CHILDREN: 15CENSUS: 4DATE:
02/26/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Rhiana Thornton TIME COMPLETED:
01:55 PM
NARRATIVE
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On 02/26/24, Licensing Program Analyst (LPA) Denisia Jimenez arrived at the facility to conduct an unannounced Case Management inspection. LPA met with Teacher Specialist, Rhiana Thornton. LPA toured the facility, and a census was taken. The purpose of today's inspection was regarding an unusual incident that was reported to the Fresno Childcare Regional Office on 02/21/24 regarding a child’s personal rights being violated.

Incident occurred at the facility where a child’s personal rights were violated. Child got up to wash its hands without being dismissed and began to hit and kick the teacher. The teacher grabbed the child by the arms and left red marks on both forearms. Child’s parents were not contacted and not advised during pick up until the next day. Madera Unified Administration conducted interviews with Staff. Madera Police Department was also notified and interviewed Staff. The Teacher Specialist stated that they will be providing Mandated Reporter Training, Challenging Behaviors Training, and Teacher Awareness Training. Teacher is not currently present at the facility.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiencies are being cited: (see next page, 809 D).



Upon receipt, the licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months." The licensee was provided a copy of the "Fact Sheet" for AB 633 (Parent Notification Requirements), along with a copy of the relevant documents this date. A completed signed copy of the LIC 9224 will be placed in each child's file.

An exit interview was conducted with Teacher Specialist, Rhiana Thornton. A copy of this report and Appeal Rights were provided and discussed with Rhiana Thornton.

A Notice of Site Visit Form was posted to parent's board and must remain posted for 30 days.
SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Denisia Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2024
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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Document Has Been Signed on 02/26/2024 01:46 PM - It Cannot Be Edited


Created By: Denisia Jimenez On 02/26/2024 at 12:54 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: LA VINA STATE PRESCHOOL
FACILITY NUMBER: 203810160

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/26/2024
Section Cited
CCR
101223(a)(3)

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101223 Personal Rights(a)The licensee shall ensure that each child is accorded the following personal rights: (3)To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.
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Staff was immediately removed from the center. Pending Investigation. The Teacher Specialist stated the Director will retraining staff on personal rights of child, reporting requirements, Mandated Reporter Training, Challenging Behaviors Training, and Teacher Awareness Training. The Teacher Specialist training stated the training will be completed by 03/15/24 due to large staffing.
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This requirement is not met as evidenced by: Based on interview, the licensee did not comply with the section cited above. Staff grabbed the child from by the arms and left red marks on both forearms which poses an immediate health, safety, or personal rights risk to persons in care.
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Type B
02/26/2024
Section Cited
CCR101212(d)(1)(f)

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(d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.
(1) Events reported shall include the following:(f) The items specified in (d)(1)(A) through (H) above shall also be reported to the child's authorized representative.
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 The Teacher Specialist stated the Director will retraining staff on personal rights of child, reporting requirements, Mandated Reporter Training, Challenging Behaviors Training, and Teacher Awareness Training. The Teacher Specialist training stated the training will be completed by 03/15/24 due to large staffing.
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This requirement is not met as evidenced by: Based on interview, the licensee did not comply with the section cited above. Staff did not report the incident to the parents which poses a potential health, safety, or pesonal rights to persons 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:Juvenal Moctezuma
LICENSING EVALUATOR NAME:Denisia Jimenez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2024


LIC809 (FAS) - (06/04)
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