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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203810223
Report Date: 02/12/2025
Date Signed: 02/12/2025 02:11:05 PM

Document Has Been Signed on 02/12/2025 02:11 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:MADISON STATE PRESCHOOLFACILITY NUMBER:
203810223
ADMINISTRATOR/
DIRECTOR:		NORA GUILLENFACILITY TYPE:
850
ADDRESS:109 STADIUM RDTELEPHONE:
(559) 675-4630
CITY:MADERASTATE: CAZIP CODE:
93637
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 14DATE:
02/12/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:10 AM
MET WITH:Graciela MendozaTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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On February 12th, 2025, Licensing Program Analyst (LPA) Julio Rodriguez conducted an unannounced case management inspection. LPA met with Teacher Graciela Mendoza. The purpose of today's inspection was to gather more information regarding an unusual incident reported to Community Care Licensing on January 30th, 2025.

During today’s inspection, LPA Rodriguez interviewed a teacher and staff member. Interviews were conducted to gather more details regarding the unusual incident report submitted involving two children drinking contaminated water. Interviews conducted confirmed that an igloo water container utilized by children was sprayed with diluted bleach solution and left overnight to ensure proper cleaning. The next day, staff filled the Igloo container with water without properly rinsing the container and two children drank water from the container resulting in possible exposure to the diluted bleach solution. Interviews conducted indicate that staff took immediate appropriate measures in addressing the incident and proper notifications were made to all involved parties. Interviews conducted indicate that staff have made changes in protocol and are taking proper measures to prevent the incident from occurring again. Although the incident occurred, it was determined to be an isolated incident and staff took appropriate measures to address the incident following appropriate policies, regulations, and reporting requirements. Children are okay and attending the center.

During the tour of the center, it was noted that the Site Supervisor listed in the system, Nora Guillen is no longer with the facility. LPA reminded staff that a Site supervisor packet needs to be submitted within 30 days to ensure proper coverage and compliance with title 22. Staff indicated that the new Site Supervisor is going to be the school principal Frank Espinosa.

Per Title 22, Division 12, Chapter 1 of the California Code of Regulations, no deficiency is being cited during today’s inspection.

Continued on 809-C.

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Julio Rodriguez
LICENSING EVALUATOR SIGNATURE: DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/12/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: MADISON STATE PRESCHOOL
FACILITY NUMBER: 203810223
VISIT DATE: 02/12/2025
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Exit interview conducted and report was reviewed with Teacher Graciela Mendoza. Appeal rights were provided.

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: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Julio Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025
LIC809 (FAS) - (06/04)
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