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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414249
Report Date: 10/29/2019
Date Signed: 10/29/2019 10:30:56 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:VHERU FAMILY CHILD CAREFACILITY NUMBER:
197414249
ADMINISTRATOR:VHERU, LORRAINE S.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 948-8191
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY:14CENSUS: 9DATE:
10/29/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Lorraine VheruTIME COMPLETED:
10:43 AM
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Licensing Program Analysts (LPA's) King-Lewis and Loyce Phillips met with Licensee, Lorraine Vheru for the purpose of a Case Management Unusual Incident inspection of an incident that occurred on October 15, 2019. This Unusual Incident was self reported. Upon arrival there were 9 child care children and 2 assistants present. Licensee Lorraine Vheru join visit at 9:25 am.

Description of incident: At approximately 6:00 PM, Child #1 (7 years old) jumped off swing, while swing was in mid-flight. Child #1 landed on his left arm and sustained a broken arm. Per Licensee, there were 7 children and 1 staff (assistant) present during the incident. Staff called parent and child was taken to the emergency room. Per staff, there were no obstructions in the area.

During this investigation, LPA's received copy of current Child Care Facility Roster, observed and took photos of the outdoor swing area, interviewed licensee, staff and children present during today inspection. At this time, based on interviews conducted and information obtained, further investigation is required.

Exit interview was conducted and a copy of this report was provided to the licensee.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019
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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