<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173003502
Report Date: 08/28/2019
Date Signed: 08/28/2019 10:12:51 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:LUCERNE EARLY CONNECTION - PRESCHOOLFACILITY NUMBER:
173003502
ADMINISTRATOR:SYLVESTER, FREYAFACILITY TYPE:
850
ADDRESS:3351 COUNTRY CLUB DRIVETELEPHONE:
(707) 274-7723
CITY:LUCERNESTATE: CAZIP CODE:
95458
CAPACITY:30CENSUS: 21DATE:
08/28/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Freya SylversterTIME COMPLETED:
10:25 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Chris Arnhold arrived to this facility to conduct a case management visit in regards to an unusual incident that occurred on 08/23/2019. LPA met with Site Supervisor Freya Sylvester and reviewed records. The incident was in regards to child 1, (C1) being bit by child 2, (C2). The bite did not break the skin. Staff cleaned the area and applied ice. Proper notifications were made to both responsible parties. Telephone report was made to CCL the same day. This was the first incident of this nature with C2.
Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Christopher ArnholdTELEPHONE: (707) 588-5056
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2019
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 1