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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243810276
Report Date: 05/21/2025
Date Signed: 05/21/2025 01:18:36 PM

Document Has Been Signed on 05/21/2025 01:18 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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:LOS BANOS CAMPUS CHILD DEVELOPMENT CENTERFACILITY NUMBER:
243810276
ADMINISTRATOR/
DIRECTOR:		MISTY MENDOZAFACILITY TYPE:
860
ADDRESS:22240 HIGHWAY 152TELEPHONE:
(209) 826-3495
CITY:LOS BANOSSTATE: CAZIP CODE:
93635
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 13DATE:
05/21/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Lydia PadronTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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On 05/21/25, Licensing Program Analyst (LPA) Martha De Haro conducted an unannounced case management inspection. LPA toured the facility, and a census was taken. LPA met with Site Supervisor Lydia Padron who is filling in for the regularly assigned Site Supervisor. The purpose of today's inspection was to discuss an unusual incident, which occurred on 05/15/25 in which a child was left unsupervised in the playground.

During the case management inspection, LPA interviewed the Site Supervisor as well as the preschool teachers and received and gathered additional documentation.

After conducting the case management inspection and interviewing staff, it was found that child #1 was left unsupervised in the playground for about 30 seconds. Per staff interviews, there were twelve (12) children present on the day of the incident. Staff #1 walked inside of the classroom with her six (6) children, and staff #2 stayed behind with six (6) additional children. Staff #2 counted only five (5) children and walked inside with those five children. Staff #2 mistakenly believed that she miscounted or that the missing child was already inside. Upon entering the classroom, both staff members recounted the children and found that child #1 had been left outside. At this time, staff #2 as well as staff #3 went to look for child #1 who was found hiding behind a large metal storage box. The child was brought back to the classroom. Per the Site Supervisor, the mother was notified of the incident right away.



Per Site Supervisor Ms. Padron, she held a meeting with all staff in which they discussed strategies on how to ensure that children are not left without supervision. They also made a safety plan for when bringing in children from outdoors or when children are leaving the classroom in order to ensure that this does not happen again. The Associate Teacher (staff #2) will be completing a Face to Name Roll Sheet throughout the day, noting down how many children are in care as well as the number of staff who are present. In addition, the last teacher or classified staff member walking behind the children will do a sweep of the area before walking inside from the playground or walking outside of the classroom. (Continued on LIC 809-C)
NAME OF LICENSING PROGRAM MANAGER: Kari McWilliams
NAME OF LICENSING PROGRAM ANALYST: Martha DeHaro
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2025
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: LOS BANOS CAMPUS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 243810276
VISIT DATE: 05/21/2025
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Per Chapter 1, Division 12, Title 22 of the California Code of Regulations, the following deficiency was cited during today’s inspection (See LIC 809-D).

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted with Site Supervisor Lydia Padron and a copy of the report and appeal rights were given and discussed.

NAME OF LICENSING PROGRAM MANAGER: Kari McWilliams
NAME OF LICENSING PROGRAM ANALYST: Martha DeHaro
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/21/2025 01:18 PM - It Cannot Be Edited


Created By: Martha DeHaro On 05/21/2025 at 01:01 PM
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: LOS BANOS CAMPUS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 243810276

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/21/2025
Section Cited
CCR
101229(a)(1)

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101229(a)(1)
(a) The licensee shall provide care and supervision as necessary to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher at any time... specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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The Site Supervisor held a meeting with all staff on the day of the incident in which they discussed strategies on how to ensure that children are not left without supervision. They also made a safety plan for when bringing children indoors or taking them outdoors. Plan of correction completed and cleared.
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This requirement was not met as evidenced by:
Based on interviews, staff confirmed that a child was left unsupervised on the playground for about 30 seconds while everyone went back inside of the classroom. This poses a potential health, safety, or personal rights risk to children in care.
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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.
Kari McWilliams
NAME OF LICENSING PROGRAM MANAGER:
Martha DeHaro
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/21/2025


LIC809 (FAS) - (06/04)
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