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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103808517
Report Date: 03/11/2022
Date Signed: 03/11/2022 05:42:23 PM


Document Has Been Signed on 03/11/2022 05:42 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:BRIGHTEN ACADEMY PRESCHOOLFACILITY NUMBER:
103808517
ADMINISTRATOR:PETERSON, KRISTINFACILITY TYPE:
850
ADDRESS:1825 AUSTIN AVE.TELEPHONE:
(559) 294-1310
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:162CENSUS: 117DATE:
03/11/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Director - Becky IharaTIME COMPLETED:
05:50 PM
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On 03/11/2022, Licensing Program Analyst (LPA) Luisa Gavoutian conducted an unannounced Case Management inspection. LPA met with Director Becky Ihara, toured the facility, and took a census. The purpose of today’s inspection was to discuss an incident that was reported to Community Care Licensing (CCL) on 02/23/2022.

Director stated that on 02/23/2022, Child 1 was playing outside on the play structure of Building 1’s small playground. Child 1 began descending the stairs of the play structure when they lost their footing and fell forward, hitting their chin on the handrail pole. Staff 1 approached Child 1 and observed a cut on the left side of their chin. Staff 1 escorted Child 1 inside, where Staff 2 and Staff 3 administered first aid and notified Child 1’s parent/authorized representative. Child 1 was picked up from the facility by the authorized representative. Later that day, staff were notified that Child 1 had sought medical treatment and had received six stitches. LPA discussed supervision at the time of the incident, and it was determined that Staff 1 had been near the play structure across from Child 1 when the incident occurred but was tending to another child and did not see the incident. Staff 1 heard when Child 1 hit the pole and immediately looked over. Staff 2 was also outside during this time and was positioned near the larger play structure and did not witness the incident. This facility has a zoning map for where teachers are to be stationed while outdoors to ensure that supervision is maintained at all times. LPA inspected the area where the incident took place and did not observe any safety hazards or areas of concern. LPA observed the play structure was age-appropriate.

Per Chapter 1, Division 12, Title 22 of the California Code of Regulations, the following deficiency is found: (see LIC809-D). Exit interview conducted and report was reviewed with the Director Becky Ihara. A copy of this report to be made available to the public upon request.

LIC 9213 Notice of Site Visit to be posted for 30 days.

SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa GavoutianTELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:
DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/11/2022
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 03/11/2022 05:42 PM - It Cannot Be Edited

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: BRIGHTEN ACADEMY PRESCHOOL

FACILITY NUMBER: 103808517

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 03/11/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/11/2022
Section Cited

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Responsibility for Providing Care and Supervision; No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement was not met as evidenced by:
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Based on interview, facility representatives failed to provide supervision in that staff did not witness how Child 1 sustained an injury. This poses a potential threat to the health, safety, or personal rights of children.
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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: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa GavoutianTELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:
DATE: 03/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/11/2022
LIC809 (FAS) - (06/04)
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