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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543801022
Report Date: 09/12/2024
Date Signed: 09/12/2024 09:35:09 AM

Document Has Been Signed on 09/12/2024 09:35 AM - 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 SOUTH CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:MAPLE TITLE I PRESCHOOLFACILITY NUMBER:
543801022
ADMINISTRATOR/
DIRECTOR:		BROWN, VALERIEFACILITY TYPE:
850
ADDRESS:640 W. CROSS AVENUETELEPHONE:
(559) 685-6500
CITY:TULARESTATE: CAZIP CODE:
93274
CAPACITY: 40TOTAL ENROLLED CHILDREN: 16CENSUS: 14DATE:
09/12/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Giselle GarciaTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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On 09/12/2024, Licensing Program Analyst (LPA) Behatriz Gonzalez conducted a Case Management inspection for an incident which occurred on 08/09/24. LPA met with Teacher Giselle Garcia. LPA toured facility inside and outside and took census.

Teacher, Giselle Garcia stated that child #1 tripped and fell a step down from the stairs playing on the playground structure. Teacher stated he was going up and down the stairs and he tripped, missed a step and fell on his nose, and was bleeding. Child was cared for while mom picked him up and took him to the emergency room. The doctor informed mom the nose was not broken, but just bruised. She stated that there was a teacher on the playground structure and had visual supervision of child #1. Child #1 accidentally tripped and stumbled down a step on the stairs. The incident happed on a Friday and the child returned on Monday.

LPA inspected the playground structure and observed that the structure is safe and did not have any blind spots for lack of supervision. LPA confirmed that the playground has soft cushion floor for all high climbing areas to absorb falls.

Per California Code of Regulations, Title 22, Division 12, no deficiency cited.

Site Visit Notice to be posted on the parent board. Exit interview was conducted with Teacher Giselle Garcia.

SUPERVISORS NAME: Scott Herring
LICENSING EVALUATOR NAME: Behatriz Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2024
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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