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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543805849
Report Date: 07/14/2023
Date Signed: 07/14/2023 02:29:18 PM

Document Has Been Signed on 07/14/2023 02:29 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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:TOMI'S DAY CAREFACILITY NUMBER:
543805849
ADMINISTRATOR:PEREZ, TOMASAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 310-4710
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
07/14/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Tomasa PerezTIME COMPLETED:
02:45 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 this date 7/14/2023, Licensing Program Analyst (LPA) Ruby Ocegueda, conducted an unannounced case management – unusual incident inspection. LPA met with licensee Tomasa Perez, toured the facility indoors and outdoors and took a census. The purpose of today's inspection was to follow-up on an unusual incident that was reported to Community Care Licensing (CCL) on 6/20/2023. The Incident reported was regarding child #1 who sustained a fracture to his/her left clavicle area.

During today's inspection, LPA interviewed staff regarding the unusual incident, reviewed personnel files, reviewed children’s file and inspected facility and outside play equipment. Per licensee on 6/20/2023, child appeared quieter than usual but was not observed crying or complaining of pain upon arrival. Child #1 is a preschool child who is 3 years old. Towards the end of the day (approximately 1:00 PM) licensee inquired with older sibling as to child #1 being quieter. Child #2 then asked child #1 what was wrong and child then stated that something hurt and that he/she fell outside. Licensee was caring for child alone while outside on this day. Licensee did not observe child fall from any equipment and child did not cry out in any distress while playing at the facility that day. Licensee stated while she and child #1 were outside, she was picking fruit and cleaning toys. Today, it could not be confirmed if child #1fell at the facility or if the injury happened elsewhere because it was not observed by anyone else.

Today, LPA Ocegueda observed that the play equipment was intact and in good working condition with no broken or sharp edges. The plastic toddler size play structure that child was playing on that day has a platform approximately 2 ft in height and the structure sits over grass. Licensee responded to the child by placing a cold pack where child stated it hurt and called parents immediately. Licensee also encouraged and assisted parents in seeking medical attention for the child. Due to reasons unrelated to this possible incident, the child has not returned to care. Report continued to 809-C
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE: DATE: 07/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2023
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: TOMI'S DAY CARE
FACILITY NUMBER: 543805849
VISIT DATE: 07/14/2023
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
26
27
28
29
30
31
32
LPA encouraged licensee to continue to monitor her equipment and to conduct health checks of children upon arrival to her facility. LPA also encouraged licensee to discuss safe use of play equipment.

Today it was determined that the facility met all reporting requirements as specified in Title 22 Regulation 101212 - Reporting Requirements. Facility submitted all required forms and information to CCL. The incident is an isolated incident and not a result of lack of care and supervision.

No deficiencies cited in the areas observed today.This report is to be made available to the public upon request.LIC 9213 Notice of Site Visit to be posted for 30 days.
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2