Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 540405030
Report Date: 04/26/2016
Date Signed 04/26/2016 03:38:28 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:GREENHOUSE MONTESSORI SCHOOLFACILITY NUMBER:
540405030
ADMINISTRATOR:HOFFMAN, ANNEFACILITY TYPE:
850
ADDRESS:4143 S. DANS LANETELEPHONE:
(559) 625-8385
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY:82CENSUS: 69DATE:
04/26/2016
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Director, Nina ClancyTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA), Norma Lomeli and Licensing Program Manager (LPM), Duane Matsubara conducted an unannounced Case Management - Incident visit on this date. LPA met with Director, Nina Clancy, toured facility inside/outside and census was taken. LPA informed director that the visit was regarding an incident submitted to Fresno Community Care Licensing where a child was playing in the east playground and jumped off from a 6 inch stage onto a log bench and hit his forehead on the log which caused child a one inch long abrasion to his forehead. LPA discussed the incident with director. LPA observed where the incident occurred and there was no evidence that there was a lack of care and supervision. As of this date, this appears to be an isolated incident and staff took appropriate measures and followed proper policies and procedures.

Per California Code of Regulations, Title 22, Division 12, Chapter 1, no deficiency cited.

Exit interview conducted with Director, Nina Clancy.

LPA observed the director post a Notice of Site Visit Form onto parent's board and understands that it must remain posted for 30 days.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)243-8103
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)243 -8416
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2016
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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