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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243808256
Report Date: 04/02/2026
Date Signed: 04/02/2026 11:00:22 AM

Document Has Been Signed on 04/02/2026 11:00 AM - 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 CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:BELLEVUE HEAD STARTFACILITY NUMBER:
243808256
ADMINISTRATOR/
DIRECTOR:		KIANA SANAJOUYANFACILITY TYPE:
850
ADDRESS:1020 EAST BELLEVUE ROADTELEPHONE:
(209) 381-5174
CITY:ATWATERSTATE: CAZIP CODE:
95301
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 15DATE:
04/02/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Kiana Sanajouyan, Site SupervisorTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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On 04/02/2026, Licensing Program Analysts (LPAs) Ka Vang and Kimberly Vass met with Site Supervisor Kiana Sanajouyan for an unannounced case management inspection. A complete file review was conducted prior to today’s inspection. LPAs toured the facility and a census was taken.

The purpose of this investigation was to follow up on an Unusual Incident Report submitted to the Fresno Community Care Licensing (CCL) office on 03/25/2026 regarding an incident that occurred on 03/24/2026. According to the report, while the children where in the outdoor play ground, Child #1 (C1) and Child #2 (C2) were playing at the water table with magnet fishing poles, Child #2 (C2) was swinging the fishing pole forward and backward when the fishing line struck Child #1 (C1) on the forehead.



During this investigation, it was confirmed that Staff #1 (S1), Staff #2 (S2), and Staff #3 (S3) supervised 17 children on the playground during the morning outdoor activity. Interviews confirmed that at the time the incident occurred, S1 was supervising and observed both children engaging in the activity appropriately. However, as Child #2 (C2) swung the fishing pole forward and backward, S1 reminded the children that the fishing pole is not swung forward and backward. As the children continued to engage, suddenly C2’s fishing line struck Child #1 (C1) on the forehead. S1 stated that the incident happened instantly, and S1 immediately attended to C1’s injury by administering first aid, cleaning the cut with antiseptic wipes, and applying an ice pack and a bandage. During the first aid process, S1 observed that C1 sustained an open wound approximately half an inch in length on C1’s forehead.

(Continued on LIC809-C).
NAME OF LICENSING PROGRAM MANAGER: Kari McWilliams
NAME OF LICENSING PROGRAM ANALYST: Ka Vang
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/02/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: BELLEVUE HEAD START
FACILITY NUMBER: 243808256
VISIT DATE: 04/02/2026
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C1’s authorized representative was contacted immediately following the incident and the attendance to C1’s injury. C1 was then taken by C1’s authorized representative for a follow-up examination at a local clinic, where it was confirmed that C1’s wound did not require stitches; however, skin glue was applied. It was confirmed that C1 returned to the facility the following day.

During this investigation, LPAs observed that the water table and magnet fishing poles were age appropriate. The water table and the fishing poles were in good condition and free of sharp, loose, or pointed parts. Interviews confirmed that all children, including C1 and C2, were under staff supervision, including visual supervision by staff members, at the time the incident occurred. It was also confirmed that teacher-child ratios were also maintained.

Based on the information obtained, this appears to be an isolated incident, and staff took appropriate measures to address the child’s injury in accordance with proper policies and procedures. No regulations were violated.

Per Title 22, Division 12, Chapter 1 of the California Code of Regulations, no deficiency was cited during today’s inspection. An exit interview was conducted with Kiana Sanajouyan .

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.

NAME OF LICENSING PROGRAM MANAGER: Kari McWilliams
NAME OF LICENSING PROGRAM ANALYST: Ka Vang
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2026
LIC809 (FAS) - (06/04)
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