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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334820772
Report Date: 09/13/2024
Date Signed: 09/13/2024 01:06:17 PM


Document Has Been Signed on 09/13/2024 01:06 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:LEUSD EARL WARREN PRESCHOOLFACILITY NUMBER:
334820772
ADMINISTRATOR:GALARZA, ADRIAFACILITY TYPE:
850
ADDRESS:41221 ROSETTA CANYON ROADTELEPHONE:
(951) 253-7810
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92532
CAPACITY:24CENSUS: 0DATE:
09/13/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Claudia Leon, SupervisorTIME COMPLETED:
01:20 PM
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On September 13, 2024 at 12:45PM, Licensing Program Analyst (LPA) William Chancellor arrived to the Childcare Center (CCC) unannounced to conduct a case management visit. This inspection was in response to the receipt of an Unusual Incident Report (UIR) received by the licensing agency on 4/17/24, regarding an incident where a child bumped their head under a table and later obtained medical attention.

Unusual incident report was reviewed and LPA conducted confidential interview's with staff 1 and Staff 2.

Based on information gathered, the facility acted appropriately and no violations have been identified. Parents were immediately notified and child was transported for medical attention.

The site has since taken extra precaution to discuss with children spatial awareness and seeking a teacher to obtain items from under the table. Children have also been instructed to problem solve on alternative ways to seek items before going under.

There are no deficiencies at this time.

An exit interview was conducted, and a copy of this report was provided to facility staff. Notice of Site Visit must be posted for 30 consecutive days.

SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: William M Chancellor Jr.TELEPHONE: 951-218-3214
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2024
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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