<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 500316980
Report Date: 05/06/2025
Date Signed: 05/06/2025 12:01:50 PM

Document Has Been Signed on 05/06/2025 12:01 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:TUOLUMNE HEAD STARTFACILITY NUMBER:
500316980
ADMINISTRATOR/
DIRECTOR:		NUNES, HEIDIFACILITY TYPE:
850
ADDRESS:707 HERNDON RDTELEPHONE:
(209) 574-8442
CITY:MODESTOSTATE: CAZIP CODE:
95351
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 26DATE:
05/06/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Kimbra HouckTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On May 6, 2025, Licensing Program Analysts (LPAs) Miguel Herrera and Elizabeth Martinez conducted an unannounced Case Management Inspection. LPA met with ECE Coordinator, Kimbra Houck. LPA toured the facility, and a census was taken. The purpose of today's inspection was regarding an Unusual Incident that was self reported to the Fresno Childcare Regional Office, the incident occurred on 04/24/2025. The incident involved child #1 sustaining an injury to the back of their head that required medical attention.

During today’s visit LPA Herrera conducted facility observations, and interviewed staff. During the facility tour LPA Herrera conducted observations in the area were the incident occurred and inspected the liquid floor tile. Per manufacturer guidelines the liquid tiles are age appropriate and intended for children 3 to 6 years old. Furthermore, the liquid tiles were used following manufacturer's guidelines.

Based on interviews, the incident occurred in the classroom's carpet area where child #1 was laying down while child #2 was attempting to set up the liquid tiles in the same area. Child #2 accidentally dropped the liquid tile and the tile landed on child #1's head.

During today’s inspection LPA Herrera observed the facility practiced proper supervision while playing inside the classroom. Furthermore, it was an isolated incident and staff took appropriate measures to address the incident, following appropriate policies, regulations, and reporting requirements. The facility removed the liquid tiles and will no longer be used for play to prevent further accidents. Teacher/child ratios are being maintained and adequate supervision is being provided during today's visit. During today's inspection LPA Herrera observed that child #1 was present and actively participating in the classroom.

Exit interview conducted and report was reviewed with ECE Coordinator, Kimbra Houck. Appeal rights were provided. Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, there are no deficiencies being cited during today’s inspection. 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.

NAME OF LICENSING PROGRAM MANAGER: Juvenal Moctezuma
NAME OF LICENSING PROGRAM ANALYST: Miguel Herrera
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/06/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
Page: 2 of 2