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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334803230
Report Date: 11/15/2022
Date Signed: 11/15/2022 04:37:50 PM


Document Has Been Signed on 11/15/2022 04:37 PM - It Cannot Be Edited

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:RCOE - GARRETSON HEAD STARTFACILITY NUMBER:
334803230
ADMINISTRATOR:YVONNE BAILEYFACILITY TYPE:
850
ADDRESS:1650 GARRETSON AVENUE, RM.6TELEPHONE:
(951) 279-4231
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY:34CENSUS: 5DATE:
11/15/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Yvonne Bailey Site Manager/DirectorTIME COMPLETED:
04:35 PM
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On the above noted date and time, a case management visit was conducted in response to the receipt of a self reported unusual incident report (UIR) from the facility. The phoned self reported UIR was received on 11/02/22 and the date of incident was 11/01/2022. LPA met with the Site Supervisor/Director to review the reported information.

Facility records were reviewed, written statements were reviewed and obtained. The child and staff mentioned as being involved were unavailable to interview. Staff statements disclosed that S1 was observed holding a child C1 arms and hands in a manner not recommended to prevent being hit by the child. The chid did not sustain a injury or bruising. The facility has taken action to ensure the needs of C1 are met and that S1 has proper training to assist with all children's needs.

Based on information gathered, the facility acted appropriately, and no violations have been identified.

At this time the facility took appropriate action by completing self-reporting requirements as required for Unusual Incidents (UIR): Notifying the Department (CDSS) within 24 hours via submission of the Unusual Incident Report LIC 624, and the cross reported to Child Protective Services (CPS). Parents were advised of the incident and the site has submitted needed referral documents.

There are no deficiencies cited.

An exit interview was conducted, Notice of Site Visit issued, and a copy of this report was provided to the Director. A copy of this report must be made available to the public upon request for 3 years.

SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Diana BraselTELEPHONE: 951-205-9491
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2022
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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