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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334818397
Report Date: 07/03/2024
Date Signed: 07/03/2024 05:26:29 PM


Document Has Been Signed on 07/03/2024 05:26 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:DISCOVERY ISLE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
334818397
ADMINISTRATOR:TONIA GOLDBACHFACILITY TYPE:
830
ADDRESS:32220 HIGHWAY 79 S.TELEPHONE:
(951) 303-8903
CITY:TEMECULASTATE: CAZIP CODE:
92592
CAPACITY:44CENSUS: 28DATE:
07/03/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Tonia Goldbach, PrincipalTIME COMPLETED:
05:40 PM
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On date and time listed, Licensing Program Analyst (LPA) William Chancellor arrived unannounced to the facility to conduct a case management visit due to an unusual incident report received on June 18, 2024. The incident involved a child running in the classroom, tripping and requiring medical attention due to hitting their forehead on a wall mounted puzzle. LPA conducted a tour of the facility, requested medical discharge paper work and interviewed four staff involved in the incident. Appropriate ratio's and supervision were observed.

Interviews revealed that staff were in ratio at the time of the incident and S1 observed C1 trip and fall, hitting their head. Confidential interviews confirmed that staff immediately administered first aid and took the necessary steps to contact the child's emergency contacts, allowing C1 to receive medical attention in a timely manner. C1 returned the next day and is still enrolled with the CCC.

An exit interview was conducted, a copy of this report, LIC 811 (Confidential Names List) and appeal rights were reviewed with and provided to Principal Tonia Goldbach. A notice of site visit was also provided and must remain posted for 30 days.

SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: William M Chancellor Jr.TELEPHONE: 951-218-3214
LICENSING EVALUATOR SIGNATURE:
DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/03/2024
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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