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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203801877
Report Date: 04/14/2021
Date Signed: 04/14/2021 12:41:45 PM

Document Has Been Signed on 04/14/2021 12:41 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:SMALL WONDERSFACILITY NUMBER:
203801877
ADMINISTRATOR:GRISSOM DEANNFACILITY TYPE:
850
ADDRESS:315 KINGS AVENUETELEPHONE:
(559) 665-7800
CITY:CHOWCHILLASTATE: CAZIP CODE:
93610
CAPACITY: 30TOTAL ENROLLED CHILDREN: 0CENSUS: 16DATE:
04/14/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Deann Grissom - DirectorTIME COMPLETED:
01:00 PM
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On 4/14/21 at 11:45am Licensing Program Analyst (LPA) Joseph Pacheco conducted an unannounced Case Management Inspection. LPA met with Director, Deann Grissom to discuss an incident report submitted to Community Care Licensing regarding an Unusual Incident that occurred on 4/621 at approximately 8:15am. Director stated that Child #1 was running while inside to the toy kitchen area. Child #1 lost their footing, tripped and fell on the edge of a wooden bed containing dolls. Staff #1 who witnessed the incident immediately tended to Child #1 and observed that two of Child #1's teeth were extremely loose and there was some bleeding. Director and Staff #1 applied pressure to the wound and immediately contacted Child #1's authorized representative who arrived within a couple of minutes. Child #1 was taken to the dentist where the two teeth were removed. Child #1 did not sustain any permanent damage and has returned to care. LPA interviewed Director, Staff #1 and Child #1 during today's inspection. LPA inspected the area where the Unusual Incident occurred. No tripping hazards were observed. No deficiencies were observed in the play equipment. Director stated that Staff are regularly reminding day care children to not run while inside and will continue to work with them. This appears to be an isolated incident and staff took appropriate measures to address the child's injury, following appropriate policies, regulations and reporting requirements.

Per California Code of Regulations, Title 22, Division 12, Chapter 1 no deficiency was cited during today's inspection.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit form is required to be posted for 30 days.
SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Joseph Pacheco
LICENSING EVALUATOR SIGNATURE: DATE: 04/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/14/2021
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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