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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 150407507
Report Date: 01/09/2020
Date Signed: 01/09/2020 02:15:27 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:SEIBERT CHILD DEVELOPMENT CENTERFACILITY NUMBER:
150407507
ADMINISTRATOR:BUYARD, RONNETTEFACILITY TYPE:
850
ADDRESS:2800 AGATE ST.TELEPHONE:
(661) 835-5470
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93304
CAPACITY:27CENSUS: 19DATE:
01/09/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Teacher, Deborah BarkerTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Jose Penate conducted a Case Management - Incident inspection for an incident which occurred on 11/20/19. LPA met with Teacher, Deborah Barker. LPA toured facility inside and outside and took census.

On 11/20/2019 Child #1 (C1) was walking towards the library/cubby area. C1 was going to reach into his cubby (lower cubby) and he kneeled, he lost his footing which caused him to trip and hit his right eyebrow on the corner of the cubby. Site Supervisor (SS) was the first to help the child and she noticed the cut and she placed gauze and applied pressure to the cut so she could stop the bleeding. SS also applied an ice pack and comforted the child. Parent was called and she immediately came to pick C1, she took him to the hospital where he received stiches on the laceration.

On the date of the incident there were 5 teachers present and each were stationed at their assigned zone stations to have clear view all children in the classroom. Assistant Teacher, Adrianna Ventura stated that C1 was the only child in the area when the incident occurred and that he fell on his own.

LPA inspected area where child was injured and verified that no obstruction was in the area to cause the child to trip and fall and cause the injury. LPA also confirmed that this injury was not caused by lack of supervision.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations no deficiencies are observed today.

Site Visit Notice posted on the parent board.

Exit interview was conducted with Teacher, Deborah Barker.

SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Jose PenateTELEPHONE: (559) 341-5860
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020
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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