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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243808761
Report Date: 06/29/2021
Date Signed: 06/29/2021 11:55:38 AM

Document Has Been Signed on 06/29/2021 11:55 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:CCCDS-FELIX TORRES CDC 1FACILITY NUMBER:
243808761
ADMINISTRATOR:PEREZ-ORDAZ, TANIAFACILITY TYPE:
850
ADDRESS:921 N. PLAINSBURG ROADTELEPHONE:
(209) 581-9000
CITY:PLANADASTATE: CAZIP CODE:
95365
CAPACITY: 35TOTAL ENROLLED CHILDREN: 35CENSUS: 15DATE:
06/29/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Tania Perez - Site SupervisorTIME COMPLETED:
12:00 PM
NARRATIVE
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On 6/29/21 Licensing Program Analyst (LPA), Joseph Pacheco met with Site Supervisor, Tania Perez for an unannounced Case Management inspection. LPA toured the facility and a census was taken. An Unusual Incident was reported to the Fresno Childcare Regional Office on 6/3/21 where Child #1 was left alone for less than a minute in the Preschool Classroom. The purpose of this inspection was to investigate the incident. LPA spoke to the Site Supervisor, Staff #1 and Staff #2 regarding the incident. Staff #1 stated that they escorted Child #1 to the Classroom. Staff #1 was not aware that Staff #2 was not in the classroom at the time that Child #1 arrived. Staff #1 then returned to the front entrance of the facility to see if any other children were arriving. Staff #1 then immediately returned to the Preschool Classroom. Staff #2 was coming back into the classroom from being outside on the playground with two other children when Staff #1 returned to the classroom. Staff #1 and Staff #2 observed Child #1 walking to the sink to wash their hands when they came back to the classroom. Child #1's authorized representative was notified. Site Supervisor conducted a Staff Meeting where policies and procedures were reviewed and revised to ensure visual supervision of children is maintained at all times.

Per Chapter 1, Division 12, Title 22 of the California Code of Regulations, the following deficiency is found (see LIC809-D): LPA provided Site Supervisor a copy of their appeal rights.

Upon receipt of a Type A violation, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. A copy of LIC 9224 was given to Site Supervisor.

LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.
SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Joseph Pacheco
LICENSING EVALUATOR SIGNATURE: DATE: 06/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2021
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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Document Has Been Signed on 06/29/2021 11:55 AM - It Cannot Be Edited


Created By: Joseph Pacheco On 06/29/2021 at 11:36 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: CCCDS-FELIX TORRES CDC 1
FACILITY NUMBER: 243808761

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/29/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/29/2021
Section Cited
CCR
101229(a)(1)

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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 information obtained during
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Site Supervisor has conducted an all staff meeting to review policies. Procedures have been revised to ensure children are visually supervised by staff at all times. Deficiency corrected.
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interviews. Interviews indicated that Child #1 was left unsupervised in the preschool classroom for less than one minute. This poses an immediate risk to the health, safety or personal rights of children in care. An immediate $500 civil penalty is being assessed.
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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:Diana deLeon
LICENSING EVALUATOR NAME:Joseph Pacheco
LICENSING EVALUATOR SIGNATURE:
DATE: 06/29/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2021


LIC809 (FAS) - (06/04)
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