330910921-2-3-2020-09-CC-NZUA-BLFUCB-20200203142742

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 330910921
Report Date: 02/03/2020
Date Signed: 02/03/2020 02:27:45 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	DSUSD/VAN BUREN ECE CENTER		FACILITY NUMBER:	330910921
ADMINISTRATOR:	ANGIE LOPEZ		FACILITY TYPE:	850
ADDRESS:	47-733 VAN BUREN STREET		TELEPHONE:	(760) 775-3877
CITY:	INDIO	STATE: CA	ZIP CODE:	92201
CAPACITY:	60	CENSUS: 46	DATE:	02/03/2020
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Debra Hoffman		TIME COMPLETED:	02:45 PM

NARRATIVE

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Licensing Program Analyst (LPA) Nelson Zuniga arrived at the facility on a case management inspection to follow-up on an unusual incident report submitted by the facility on 01/30/2020. At the time of visit, LPA toured the facility (specifically where the reported incident took place), took census, and met with head teacher, Debra Hoffman to discuss the reported incident. During the visit, LPA also spoke with the Teacher who witnessed the incident as it took place.

A child in care was playing outside in the doll house. Child was hit by another child with a toy on the left side of the child forehead causing a cut. Child was taken to hospital, two tape strips were placed on the cut.

Based on the information obtained during the visit, as well as an inspection of the doll house where incident took place, there appeared to be no violations of Title 22 Regulations pertaining to the reported incident.

An exit interview was held. A Notice of Site visit was issued, along with a copy of this report. This report shall be public record for three years.

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Nelson Zuniga	TELEPHONE: (951) 782-6634
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2020

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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