Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103801117
Report Date: 08/11/2016
Date Signed 08/11/2016 02:20:58 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 E.SHAW AV,STE 300-MS 29-01
FRESNO, CA 93710
FACILITY NAME:KIDS KARE WESTFACILITY NUMBER:
103801117
ADMINISTRATOR:JACK, DEANAFACILITY TYPE:
840
ADDRESS:3375 W. FIG GARDEN DRIVETELEPHONE:
(559) 438-1921
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY:72CENSUS: 56DATE:
08/11/2016
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Andrea RamirezTIME COMPLETED:
02:30 PM
NARRATIVE
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An unannounced case management visit was made today at this school age center by LPA Patricia Musso.
This Case Management visit is made today to discuss this center's procedures of how illnesses and/or outbreaks are documented.

LPA was told on a previous visit that this center does not keep records of when a child has, or
comes down with a disease, or when a parent notifies this center of their child having a disease.

LPA suggest that some sort of documentation's should be kept. This type of practice would accurately define the time of when an unusual incident needs to be reported to CCL for any
disease outbreak.
Andrea said that she believes management has recently talked about this issue. Andrea said that
she has a log that she will to propose to management to use to document any and all illnesses and
or diseases.

No deficiencies cited during today's visit.

During exit interview LPA viewed the posting of the LIC9213 that was provided and left instructions to post for 30 days.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)243-8103
LICENSING EVALUATOR NAME: Patricia MussoTELEPHONE: (559) 341-5422
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2016
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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