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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334840382
Report Date: 07/30/2020
Date Signed: 07/30/2020 03:59:40 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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:CRAYON RANCH CHILD CARE CENTERFACILITY NUMBER:
334840382
ADMINISTRATOR:CRYSTAL SHOULTSFACILITY TYPE:
840
ADDRESS:25145 VISTA MURRIETA ROADTELEPHONE:
(951) 677-3303
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY:52CENSUS: DATE:
07/30/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:CRYSTAL SHOULTSTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Sean Williams made an unannounced phone call to CRAYON RANCH CHILD CARE CENTER for the purpose of conducting a Case Management Tele-Visit, to follow-up on an Unusual Incident Report (UIR). The incident is regarding a child that injured their shoulder while in the facilities care. LPA spoke with Director, Crystal Shoults. LPA interviewed the Director and gathered more information pertaining to this incident.

Based on the information obtained for this incident, there is no indication that a violation of Title 22 Regulations occurred. Staff members did take the necessary steps to ensure the child's needs were met during and after the incident took place. The child returned to the facility and is currently attending with no further incident.

Due to the COVID-19 State of Emergency, this report was completed via Tele-Inspections Report Delivery Instructions. Licensee's signature will be obtained via email. Licensee will receive a copy of this report via email. A NOTICE OF SITE VISIT WAS NOT LEFT AT THE FACILITY DUE TO THIS BEING A TELE- INSPECTION.

This report must be made available to the public upon request for the next 3 years
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Sean R WilliamsTELEPHONE: (951) 204-2046
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2020
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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