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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334816758
Report Date: 10/03/2023
Date Signed: 10/03/2023 11:02:44 AM


Document Has Been Signed on 10/03/2023 11:02 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:LEUSD WILDOMAR PRESCHOOLFACILITY NUMBER:
334816758
ADMINISTRATOR:ADRIA GALARZAFACILITY TYPE:
850
ADDRESS:21575 PALOMAR RD.TELEPHONE:
(951) 253-7555
CITY:WILDOMARSTATE: CAZIP CODE:
92595
CAPACITY:48CENSUS: 33DATE:
10/03/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Claudia LeonTIME COMPLETED:
11:15 AM
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At 10:30AM on October 3, 2023, a case management visit is being conducted in response to the receipt of an unusual incident report (UIR) from the facility. LPA met with Early Childhood Education Supervisor Claudia Leon. The UIR was received by the licensing agency on 09/13/2023.

It indicates that on 09/13/23, students went out to the playground to play. Teacher called out to Child #1 (C1) to move, because C1 was standing in front of the swings. Teacher began to walk towards C1, when another child on the swing feet made contact to the left side neck/jaw line area of C1. C1 fell to the ground crying. The teacher helped C1 to feet and conducted a head to toe check. C1 was in pain and teacher comforted C1 and applied an ice pack. C1 had a red mark and bump on the left clavicle. Teacher and C1 sat on the grass under a tree, so that a phone call could be made to C1's parent. Parent responded, was given an incident report and transported C1 to urgent care. Parent contacted facility and informed that C1 has a broken bone.

Administration met with parent on 09/18/23, to discuss the incident and how to prevent incidents like this in the future and zone in areas, active supervision, etc. It was determined that staff were in the right zone areas and actively supervising children. Parent advised C1 would need assistance with toileting, putting clothes back on, with feeding and manipulative. C1 returned to school on 09/19. They have assigned a staff to shadow and assist C1 throughout the school day. Mrs. Leon advised there haven't been any further incidents.

LPA received copies of all relevant paperwork. Based on information gathered, the facility acted appropriately and no violations have been identified.

An exit interview was conducted and a copy of this report was provided to ECE Supervisor Claudia Leon..

SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 505-6334
LICENSING EVALUATOR NAME: Alaina WilburnTELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2023
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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