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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 163810031
Report Date: 06/07/2021
Date Signed: 06/07/2021 02:43:05 PM

Document Has Been Signed on 06/07/2021 02:43 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:KCAO ARMONA LEARNING CENTERFACILITY NUMBER:
163810031
ADMINISTRATOR:AVILA, TERESAFACILITY TYPE:
850
ADDRESS:13835 LYN STTELEPHONE:
(559) 584-8946
CITY:ARMONASTATE: CAZIP CODE:
93202
CAPACITY: 48TOTAL ENROLLED CHILDREN: 0CENSUS: 12DATE:
06/07/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Miguel RodriguezTIME COMPLETED:
03:00 PM
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On 6/7/2021, Licensing Program Analyst (LPA) Ocegueda conducted a case management incident inspection for the purpose of reviewing the Unusual Incident that was reported to Community Care Licensing on 5/28/2021. Today, LPA conducted a Covid-19 health screening and upon arrival provided identification, took a census and toured the facility.

Today LPA Ocegueda interviewed staff #1 who was present and was the primary staff involved. LPA reviewed details and outcomes surrounding the incident. The Unusual Incident was regarding a child (child #1) who was choking on his food during meal time. Staff #1 stated that child #1 was observed to be chewing while walking. Child#1 was advised to sit back down at the table to finish his food (a sandwich). Staff #1 explained to the child that if he/shw was done eating and didn't want his/her food he/she could spit it out in the garbage bin (that is covered). While child was about to spit it out, child was observed to shake his/her body and flap his/her arms and staff noticed he/she was chocking. Staff #1 began to pat his/her firmly to dislodge the food from child's throat. When this failed, staff immediately used his/her fingers to remove the food from child's mouth clearing his path way. Child #1 immediately resumed normal breathing/behavior and his parent was called by Site Supervisor immediately. Parent did not come to pick child up and no medical attention was required (the ambulance was not called). No other choking incidents have occurred since.

Staff #1 discussed the incident further with parent who stated that the child does have a history of eating quickly and stuffing his/her mouth while eating. As an extra precaution, staff #1 stated that they will continue to remind child#1 to eat slowly and ensure he/she does not stuff his/her mouth during meal times. Staff records were reviewed and current CPR/First Aid was observed for Site Supervisor and multiple other staff. Child record review did not indicate or reveal any known medical issues making child#1 predisposed for choking issues.
Report Continued on 809-C
SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2021
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: KCAO ARMONA LEARNING CENTER
FACILITY NUMBER: 163810031
VISIT DATE: 06/07/2021
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During todays inspection, LPA Ocegueda determined that the facility met all reporting requirements as specified in Title 22 Regulation 101212 - Reporting Requirements. The incident was 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: Michael Duarte
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2021
LIC809 (FAS) - (06/04)
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