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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 540404974
Report Date: 05/09/2022
Date Signed: 05/09/2022 02:55:11 PM

Document Has Been Signed on 05/09/2022 02:55 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:KAWEAH KIDS' CENTERFACILITY NUMBER:
540404974
ADMINISTRATOR:HARDIE, KATHRYNFACILITY TYPE:
850
ADDRESS:507 W. WILLOWTELEPHONE:
(559) 624-2170
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 98TOTAL ENROLLED CHILDREN: 98CENSUS: 43DATE:
05/09/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Melissa Chavez - Assistant DirectorTIME COMPLETED:
03:00 PM
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On 5/09/22, Licensing Program Analyst (LPA) Jessika Thompson met with Assistant Director Melissa Chavez for an unannounced case management inspection. A complete file review was conducted prior to today's inspection. LPA toured the facility and a census was taken. The purpose of today's inspection was to address an unusual incident that occurred at the facility on 3/21/22.

An Unusual Incident Report was submitted to the Fresno Community Care Licensing Office (CCL) regarding an incident that occurred on 3/21/22 involving a day-care child that jumped off a tree stump, which resulted in the child falling and sustaining a leg strain. Today, LPA spoke with Staff #1 who reportedly witnessed the incident as it occurred. Staff #1 stated that Child #1 was playing in the outdoor play area when he jumped from a large tree stump, and landed in rubber mulch. Staff #1 stated that she was in close proximity the child when this incident occurred. Staff #1 stated the child fell to his knees upon jumping and was noticeably limping immediately thereafter. First aid was provided and the child's parent was notified. The child was taken to see a physician on the date of occurrence where the child was reportedly diagnosed with a leg strain.

Today, LPA observed the outdoor play area where the incident took place. There was adequate rubber mulch in place; play equipment observed appeared to be age appropriate. LPA inspected the tree stump in question. The tree stump is approximately 13.5 inches tall and 14.5 inches in diameter. The surface of the tree stump is flat with no visible defects. There were two teachers to approximately 16 children in the outdoor play area when the incident occurred; therefore, adequate ratios were in place. Ms. Chavez reported that Child #1 has fully recovered and returned to care on 3/28/22.

Ms. Chavez stated that staff ensures that adequate care and supervision is provided to all children in care. Ms. Chavez stated that staff have been instructed to closely monitor children as they are playing on, or around tree stumps within the play area.

Based on the information obtained, LPA determined the licensee handled the incident correctly and reporting requirements were met (see next page, LIC809C).
SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Jessika Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: KAWEAH KIDS' CENTER
FACILITY NUMBER: 540404974
VISIT DATE: 05/09/2022
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LPA determined that the licensee took appropriate measures to address the incident, following both internal policy and Title 22 Regulations.

Per California Code of Regulations ,Title 22, Division 12, no deficiency was cited during today's inspection.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Ms. Chavez.
SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Jessika Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2022
LIC809 (FAS) - (06/04)
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