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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503604250
Report Date: 11/08/2022
Date Signed: 11/08/2022 12:34:16 PM

Document Has Been Signed on 11/08/2022 12:34 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:ALBERTA MARTONE PREFORMAL CENTERFACILITY NUMBER:
503604250
ADMINISTRATOR:NUNES, HEIDIFACILITY TYPE:
850
ADDRESS:1413 POUST ROADTELEPHONE:
(209) 574-8172
CITY:MODESTOSTATE: CAZIP CODE:
95351
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 17DATE:
11/08/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Heidi NunesTIME COMPLETED:
12:45 PM
NARRATIVE
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On 11/08/22, Licensing Program Analyst (LPA) Araceli Gibson conducted an unannounced case management inspection. LPA met with Senior Director Heidi Nunes, ECE Coordinator Kimbra, Draper. The purpose of today’s inspection is to address reporting responsibilities for day care centers.

On 09/12/22 LPA Gibson received a complaint pertaining to an injury to a child and by process of the investigation discovered the facility failed to report the incident to CCLD, as required. This incident involved Staff #1 conducting themselves in a manner that affected the Personal Rights of children in care. LPA Gibson discussed reporting requirements with the Senior Director Heidi Nunes, ECE Coordinator Kimbra, Draper and the responsibility of the facility to report all unusual incidents to CCLD within 24 hours of occurrence. CCR Section 101212(d)(1)(C)(D) states, “(d) Upon the occurrence, during the operation of the childcare 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: (C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.”. (D) Any suspected physical or psychological abuse of any child." LPA issued a Type B citation (see LIC 809D)

Per Chapter 1, Division 12, Title 22 of the California Code of Regulations, the following deficiency is cited: (see LIC809-D). Exit interview conducted and report was reviewed with Senior Director Heidi Nunes, ECE Coordinator Kimbra, Draper.

A notice of site visit was given and must remain posted for 30 days, along with a copy of this report.

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Araceli Gibson
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2022
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 11/08/2022 12:34 PM - It Cannot Be Edited


Created By: Araceli Gibson On 11/08/2022 at 09:14 AM
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: ALBERTA MARTONE PREFORMAL CENTER
FACILITY NUMBER: 503604250

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/08/2022
Section Cited
CCR
101212(d)

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(d) Upon the occurrence… a report shall be made to the Department by telephone or fax within the Department's next working day... In addition, a written report... shall be submitted... within seven days.... (1) Events reported shall include... (c) any unusual incident or child absence that threatens the physical or emotional health or safety of any child. This requirement was not met as evidenced by:
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Licensee agreed to complete a training for all teachers,Family Services Specialist, Health and Safety Specialist and Administrators on the Child Care Reporting Requirements through the California Child Care Licensing LPA provided Licensee with the information of where to get the training material.
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Based on records reviewed, interviews and observation, Licensee failed to report incident of staff causing an injury to a child. This poses a potential health, safety, or personal rights risk to persons in care.
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 Licensee is to submit a written agenda and sign in sheets as proof that Licensee completed the training with staff to Community Care Licensing-Fresno Regional Office by 12/08/22 see website: https://ccld.childcarevideos.org/child-care-center-operators/child-care-reporting-requirements/

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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:Araceli Gibson
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2022


LIC809 (FAS) - (06/04)
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