TEAGUE ELEMENTARY

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On 05/27/2025, Licensing Program Analyst (LPA) Vang conducted an unannounced case management inspection. LPA toured the facility and a census was taken. LPA explained to Staff #1 (S1) the purpose of today’s inspection was to follow up with an unusual incident reported to Community Care Licensing (CCL)-Fresno Office on 05/08/2025 via email. Per the Unusual Incident Injury Report (LIC 624), Child #1 (C1) complained of pain, and it was later determined by Valley Children Hospital’s physician that C1 sustained a fracture on his right arm. On 05/08/2025, LPA Vang received LIC 624 via email stated that on 04/28/2025 at 10:45 a.m., C1 was found by S1 under the play structure, and C1 complained of arm pain. Due to C1 limited English language, C1 informed S1 that he was running and fell, but did not provide further details. S1 then applied an ice pack on C1’s arm and observed that there was no open wound or bruises on C1’s arm. At the end of class session, C1’s authorized representative (AR) was informed of the incident that C1 complained of pain in C1’s arm. Based on interviews, C1 did not return to facility the following day, 04/29/2025 or 04/30/2025, therefore, S1 contacted C1’s AR via email. On 04/30/2025, C1’s AR informed S1 that C1 was seen by Valley Children's Hospital physician and confirmed to had a fracture on C1's right arm; therefore, C1 was out on 04/29/2025, 04/30/2025. C1 was out of class from 04/29/2025 to 05/02/2025 and returned to the facility on 05/05/2025. The above incident of C1 sustained an injury and was seen by a medical doctor was not reported to CCL-Fresno Office within the next working day of the Department’s normal business day although staff member became aware of C1's right arm fracture on 04/30/2025. The incident was reported to CCL-Fresno Office on 05/08/2025. (Continued on LIC809-C). NAME OF LICENSING PROGRAM MANAGER: Kari McWilliams NAME OF LICENSING PROGRAM ANALYST: Ka Vang LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/27/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/27/2025 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) - (06/04)Page: 1 of 4 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 corr

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On 05/27/2025, Licensing Program Analyst (LPA) Vang conducted an unannounced case management inspection. LPA toured the facility and a census was taken. LPA explained to Staff #1 (S1) the purpose of today’s inspection was to follow up with an unusual incident reported to Community Care Licensing (CCL)-Fresno Office on 05/08/2025 via email. Per the Unusual Incident Injury Report (LIC 624), Child #1 (C1) complained of pain, and it was later determined by Valley Children Hospital’s physician that C1 sustained a fracture on his right arm. On 05/08/2025, LPA Vang received LIC 624 via email stated that on 04/28/2025 at 10:45 a.m., C1 was found by S1 under the play structure, and C1 complained of arm pain. Due to C1 limited English language, C1 informed S1 that he was running and fell, but did not provide further details. S1 then applied an ice pack on C1’s arm and observed that there was no open wound or bruises on C1’s arm. At the end of class session, C1’s authorized representative (AR) was informed of the incident that C1 complained of pain in C1’s arm. Based on interviews, C1 did not return to facility the following day, 04/29/2025 or 04/30/2025, therefore, S1 contacted C1’s AR via email. On 04/30/2025, C1’s AR informed S1 that C1 was seen by Valley Children's Hospital physician and confirmed to had a fracture on C1's right arm; therefore, C1 was out on 04/29/2025, 04/30/2025. C1 was out of class from 04/29/2025 to 05/02/2025 and returned to the facility on 05/05/2025. The above incident of C1 sustained an injury and was seen by a medical doctor was not reported to CCL-Fresno Office within the next working day of the Department’s normal business day although staff member became aware of C1's right arm fracture on 04/30/2025. The incident was reported to CCL-Fresno Office on 05/08/2025. (Continued on LIC809-C). NAME OF LICENSING PROGRAM MANAGER: Kari McWilliams NAME OF LICENSING PROGRAM ANALYST: Ka Vang LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/27/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/27/2025 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) - (06/04)Page: 1 of 4 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 corr

Type B citation - potential risk if not corrected