Children’s Choice Learning Center - Fresno

Responsibilities of Caregivers - Know number of children responsible for

“A caregiver did not know the number of children they were responsible for during the inspection. The caregiver stated there were 18 children and there were only 17 children present. Note: Discussed with the provider the importance of caregivers knowing how many children they have at all times.”

Rule 746.1205(a)(2). High, by Texas’s label. Correction date, as Texas HHSC recorded it: Jul 26, 2023. Correction verified: Aug 4, 2023.

Training Requirements for Employees, Caregivers, and Directors - Pediatric First Aid with Rescue Breathing

“A caregiver with unsupervised access to children was in a classroom and does not have current CPR and First Aid training.”

Rule 746.1301(a)(3)(A). Medium High, by Texas’s label. Correction date, as Texas HHSC recorded it: Aug 4, 2023. Correction verified: Aug 2, 2023.

Prohibited Punishments - Grabbing and Pulling

“Based upon the information obtained, there was sufficient evidence to support caregivers grabbed a child by the arm.”

Rule 746.2805(3). High, by Texas’s label. Correction date, as Texas HHSC recorded it: Jun 29, 2023. Correction verified: Jul 13, 2023.

Prohibited Punishments - Humiliating, Rejecting, Yelling

“Based upon the information obtained, there is sufficient evidence to support caregivers have yelled at the children and told them to shut up.”

Rule 746.2805(5). High, by Texas’s label. Correction date, as Texas HHSC recorded it: Jun 29, 2023. Correction verified: Jul 13, 2023.

Annual Fire Inspection - Before Initial Permit Issued and Every 12 Months

“The annual fire inspection has not been conducted since 5/26/2022.”

Rule 746.5101(a). High, by Texas’s label. Correction date, as Texas HHSC recorded it: Jun 8, 2023. Correction verified: Jun 20, 2023.

Training Requirements for Employees, Caregivers, and Directors - Pediatric CPR

“1 out of 10 staff records evaluated did not show current training in Pediatric CPR and First Aid.”

Rule 746.1301(a)(4)(A). Medium High, by Texas’s label. Correction date, as Texas HHSC recorded it: May 31, 2023. Correction verified: May 30, 2023.

Required Admission Information - Special Needs Statement

“3 out of 10 children’s files evaluated did not contain a completed special needs statement.”

Rule 746.605(13). Medium High, by Texas’s label. Correction date, as Texas HHSC recorded it: Jun 7, 2023. Correction verified: May 30, 2023.

Immunization Records, Exceptions, and Exemptions Current

“2 out of 10 children’s files evaluated did not contain current immunizations.”

Rule 746.613(b). Medium High, by Texas’s label. Correction date, as Texas HHSC recorded it: Jun 7, 2023. Correction verified: May 30, 2023.

Sign-in and Sign-out Tracking System

“11 children in the K2 classroom had not been signed in on the sign in and out log. Note: This was corrected at the inspection when the caregiver signed each child in.”

Rule 746.631(a). Medium High, by Texas’s label. Corrected during the inspection. Correction date, as Texas HHSC recorded it: May 24, 2023.

Training Criteria - Learning Objectives

“The Pre-Service training certificates do not state learning objectives for 5 out of 10 staff records evaluated.”

Rule 746.1317(c)(1). Medium Low, by Texas’s label. Correction date, as Texas HHSC recorded it: Jun 7, 2023. Correction verified: Jun 22, 2023.

Documentation PEDIATRIAC CPR-1st aid original certificate on file at center or copy available if licensing requests

“A copy of the directors CPR and First Aid training certificate was not available for review during the inspection.”

Rule 746.1329(c)(2). Low, by Texas’s label. Correction date, as Texas HHSC recorded it: May 31, 2023. Correction verified: May 30, 2023.

Responsibilities of Caregivers - Know children’s names and ages

“Caregivers in charge of a group of children 4-10yrs old were not aware of the ages of children in their car. Caregivers stated they did not know the age but believed the child was in the 4th grade or 8yrs old. One caregiver was heard asking children how old they were.”

Rule 746.1205(a)(3). Medium High, by Texas’s label. Correction date, as Texas HHSC recorded it: Mar 14, 2023. Correction verified: Apr 14, 2023.

Responsibilities of Caregivers - Know Minimum Standards

“A caregiver did not know the number of children in the classroom during the inspection. Caregiver stated there were 15 children and after counting there were only 14 children accounted for.”

Rule 746.1203(1). High, by Texas’s label. Correction date, as Texas HHSC recorded it: Mar 3, 2023. Correction verified: Mar 14, 2023.

Director Responsibilities - Operate in Compliance

“Based on the information obtained during the investigation, the director provided inaccurate information to parents regarding the incident that occurred on 2/28. The director informed parents the operation had a “medical emergency.””

Rule 746.1003(1). High, by Texas’s label. Correction date, as Texas HHSC recorded it: Mar 30, 2023. Correction verified: Apr 14, 2023.

Responsibilities of Employees and Caregivers -Demonstrate Competency, Good Judgment, Self-control

“Caregivers failed to use good judgement and maintain self-control when they engaged in a physical altercation in the presence of children.”

Rule 746.1201(1). High, by Texas’s label. Correction date, as Texas HHSC recorded it: Mar 30, 2023. Correction verified: Apr 14, 2023.

Responsibilities of Employees and Caregivers -Relate to Children

“Based on the information obtained during the investigation, caregivers failed to treat children with courtesy and respect when they used profane language in the presence of children.”

Rule 746.1201(2). High, by Texas’s label. Correction date, as Texas HHSC recorded it: Mar 30, 2023. Correction verified: Apr 14, 2023.

Report Situation Placing Children at Risk

“Operation failed to notify CCR that a physical altercation occurred between two caregivers in the presence of children, which placed the children at risk.”

Rule 746.305(a)(6). High, by Texas’s label. Correction date, as Texas HHSC recorded it: Mar 30, 2023. Correction verified: Apr 14, 2023.

Parental Communication - Situation that Placed a Child at Risk

“The operation failed to notify parents of a situation that placed children at risk.”

Rule 746.307(b)(4). High, by Texas’s label. Correction date, as Texas HHSC recorded it: Mar 30, 2023. Correction verified: Apr 14, 2023.

Responsibilities of Caregivers - Interact positively with children

“Based on the information obtained during the investigation, a caregiver failed to interact positively with a child in their care. After a child rolled their eyes at a caregiver, the caregiver responded to the child stating they don’t play with children and did not care if the child told on them. The caregiver then told the child to let their parent know they don’t play with children.”

Rule 746.1203(5). Medium High, by Texas’s label. Correction date, as Texas HHSC recorded it: Mar 30, 2023. Correction verified: Apr 14, 2023.

Child/ Caregiver Ratio - 13 or More Children

“Based on the information obtained during the investigation, there was sufficient information to support there have been times where one caregiver was left to supervised more than 11 2yr old children at one time.”

Rule 746.1601. Medium High, by Texas’s label. Correction date, as Texas HHSC recorded it: Mar 30, 2023. Correction verified: Apr 14, 2023.

Licensing Incident/Illness Report Form - Situations Placing Children at Risk

“incident reports were not made for children present during a situation that placed them at risk. Incident reports were not created until after notified by CCR. Once created, incident reports were made available for 11 of 17 children present.”

Rule 746.701(5). Medium, by Texas’s label. Correction date, as Texas HHSC recorded it: Mar 30, 2023. Correction verified: Apr 14, 2023.

Incident/Illness Report Form Shared with Parent

“Operation failed to share incident reports with parents. The incident occurred on 2/28. The first incident report created by the operation was 3/21”

Rule 746.707. Medium, by Texas’s label. Correction date, as Texas HHSC recorded it: Mar 30, 2023. Correction verified: Apr 14, 2023.

Maintenance of Building, Grounds and Equipment

“During the inspection, the screws to the back of the toilet seat in the pre-k readiness classroom was loose and unsteady. The wall in the school-age classroom contained chipped pieces of wood and paint that was observed on the floor. Note: The provider corrected the toilet during the inspection.”

Rule 746.3407. Medium High, by Texas’s label. Correction date, as Texas HHSC recorded it: Jan 26, 2023. Correction verified: Jan 25, 2023.

Responsibilities of Employees and Caregivers -Demonstrate Competency, Good Judgment, Self-control

“Based on the DFPS Investigation, a caregiver failed to practice good judgment by grabbing and pulling a child up by the wrist causing them to sustain a sprained arm.”

Rule 746.1201(1). High, by Texas’s label. Correction date, as Texas HHSC recorded it: Dec 2, 2022. Correction verified: Dec 16, 2022.

AP Responsibilities of Employees and Caregivers -Ensure No Child Abused, Neglected, or Exploited

“Based upon the DFPS Investigation, there is sufficient evidence showing a child sustained an injury to their arm while in care.”

Rule 746.1201(4). High, by Texas’s label. Correction date, as Texas HHSC recorded it: Dec 2, 2022. Correction verified: Dec 16, 2022.

Floors, ceilings and Walls in Good Repair and Clean

“There is paint chipping on the walls in the toddler classroom and in the restroom.”

Rule 746.3407(9). Medium High, by Texas’s label. Correction date, as Texas HHSC recorded it: Sep 27, 2022. Correction verified: Sep 23, 2022.

Safety - Areas Free From Hazards

“There are 4 active ant beds in the outdoor play areva.”

Rule 746.3701. Medium High, by Texas’s label. Correction date, as Texas HHSC recorded it: Sep 27, 2022. Correction verified: Sep 26, 2022.

Maintenance Procedures for Active Play - Hazards Removed or Repaired

“A play structure is missing 12 caps which pose a risk to children’s safety.”

Rule 746.4751(c). Medium High, by Texas’s label. Correction date, as Texas HHSC recorded it: Sep 27, 2022. Correction verified: Sep 26, 2022.

Written Feeding Instructions - Signed and Dated by Parent or Health-Care Professional

“The feeding sheets for 2 infants has not been signed by the parents.”

Rule 746.2421(a). Medium, by Texas’s label. Correction date, as Texas HHSC recorded it: Sep 27, 2022. Correction verified: Sep 23, 2022.

Written Operational Policies - Promotion of Physical Activity

“The operational policies do not contain the promotion of physical activities regarding the following: (A) The benefits of physical activity and outdoor play (C) The type of physical activity (structured and unstructured) that children may engage in at your operation (D) Each setting in which your physical activity program will take place (F) A plan to ensure physical activity occurs on days when extreme weather conditions prohibit or limit outdoor play.”

Rule 746.501(a)(18). Medium, by Texas’s label. Correction date, as Texas HHSC recorded it: Sep 27, 2022. Correction verified: Sep 26, 2022.

Responsibilities of Employees and Caregivers -Demonstrate Competency, Good Judgment, Self-control

“Based on the DFPS investigation, there is sufficient evidence to suggest that a caregiver did not demonstrate good judgement when handling a child aggressively.”

Rule 746.1201(1). High, by Texas’s label. Correction date, as Texas HHSC recorded it: Oct 20, 2022. Correction verified: Nov 4, 2022.

Interference with an investigation

“Based on the DFPS investigation, there is sufficient evidence to suggest that the operation interfered in an active investigation by not providing requested materials.”

Rule HRC42.04412(a). High, by Texas’s label. Correction date, as Texas HHSC recorded it: Oct 20, 2022. Correction verified: Nov 4, 2022.

Child/ Caregiver Ratio - 13 or More Children

“Based on the video clip of incident, there were 13 two years old with one caregiver. Class was out of ratio by two children. The maximum caregiver can have is 11 two years old with one caregiver but video showed 13 children with one caregiver.”

Rule 746.1601. Medium High, by Texas’s label. Correction date, as Texas HHSC recorded it: Mar 30, 2022. Correction verified: Mar 31, 2022.