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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173008693
Report Date: 03/04/2020
Date Signed: 03/04/2020 12:27:27 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:EAST LAKE EARLY CONNECTIONFACILITY NUMBER:
173008693
ADMINISTRATOR:RALLS, JESSIEFACILITY TYPE:
850
ADDRESS:13050 HIGH VALLEY ROADTELEPHONE:
(707) 998-3387
CITY:CLEARLAKE OAKSSTATE: CAZIP CODE:
95423
CAPACITY:24CENSUS: 10DATE:
03/04/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Jessie Ralls, Site SupervisorTIME COMPLETED:
12:40 PM
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A case management inspection was made to the facility by Licensing Program Analyst (LPA) N. Cunningham in response to an Unusual Incident Report (UIR) received on 12/13/19. Site Supervisor reported that at 11:30 a.m. on 12/12/19, Child 1 became upset with Child 2 because they marked on Child 1’s paper with a marker. When Child 2 heard the word “no” they quickly bit Child 1 on the shoulder.

This incident was reported to Community Care Licensing as required. Based on information available at this time, it does not appear that the incident resulted due to a lack of supervision or any other deficiency of Title 22 regulations. The Site Supervisor has developed an action plan and covered the plan with all staff. The plan includes additional supervision, reinforcing positive behavior, and addressing situations that cause frustration. There were no Title 22 deficiencies cited during today's inspection.
Notice of Site Visit shall be posted for 30 days from today's inspection.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Nicolette CunninghamTELEPHONE: (707) 588-5056
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2020
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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