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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543808537
Report Date: 11/15/2024
Date Signed: 11/15/2024 12:01:58 PM

Document Has Been Signed on 11/15/2024 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 SOUTH CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:PLANO AVENUE PRESCHOOL-PUSDFACILITY NUMBER:
543808537
ADMINISTRATOR/
DIRECTOR:		ORTIZ, REBECCAFACILITY TYPE:
850
ADDRESS:1061 S. PLANO AVENUETELEPHONE:
(559) 782-7120
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 144TOTAL ENROLLED CHILDREN: 144CENSUS: 58DATE:
11/15/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Ben IrrizarryTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 11/15/2024, Licensing Program Analyst (LPA) Octavia Nolan conducted an unannounced case management inspection. LPA met with Facility Representative Ben Irizarry. LPA toured the facility inside and outside and took a census.

On 10/02/2024, the facility notified Community Care Licensing Office (CCL) of an Unusual Incident via email. Facility confirmed the incident took place on 09/24/2024 at approximately 2:45 PM during the scheduled outdoor activity time. Child #1 was playing in the sandbox when Child #2 approached them and pushed Child #1 in the chest area. Child #1 fell back and hit his head on the ground which is cement. Staff #1 examined the head injury and applied an ice pack. The parent of Child #1 was informed of the incident during pick up. The parent called the facility later that day for more information on the incident. Child #1 returned to care 09/25/2024- 09/26/2024 and staff did not witness any signs of distress. The parent of Child #1 took them to Valley Children’s Hospital on 09/27/2024 and the child was diagnosed with a concussion. Child #1 returned to care on 09/30/2024 and is doing fine.

LPA inspected the area where the incident took place, obtained records, and interviewed Staff #1. There are no hazards present on the playground area. Staff have been trained on zoning and supervision during the outdoor activity time. This appears to be an isolated incident and staff took appropriate measures to address the child’s injury. LPA reminded staff to report any injuries to a child that requires medical treatment within the Department’s next working day, during normal business hours.

Exit interview conducted and report was reviewed with Facility Representative Ben Irizarry. Appeal rights were provided.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, no deficiencies are cited.
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.
SUPERVISORS NAME: Gloria Reyes
LICENSING EVALUATOR NAME: Octavia Nolan
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2024
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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