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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360910586
Report Date: 03/06/2020
Date Signed: 03/06/2020 03:19:26 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:CONCORDIA CHRISTIAN SCHOOLFACILITY NUMBER:
360910586
ADMINISTRATOR:DEBORA BARAJASFACILITY TYPE:
840
ADDRESS:420 AVENUE ETELEPHONE:
(760) 256-8979
CITY:BARSTOWSTATE: CAZIP CODE:
92311
CAPACITY:30CENSUS: 17DATE:
03/06/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:03 PM
MET WITH:Debora BarajasTIME COMPLETED:
03:25 PM
NARRATIVE
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LPA Mabika conducted a case management inspection and met with Site Supervisor Debora Barajas for the purpose of concluding the investigation on a self reported unusual incident of a child getting injured on the playground on 02/27/2020 and was reported to the Department on 02/28/2020.
Upon arrival, LPA observed 17 children being supervised by 2 Staff persons.

Based on the information obtained during the interviews conducted was evidence of lack of supervision as the injured child physically got off the slide set by herself and sought out staff to report the injury by herself hence a deficiency is being cited. The facility is encouraged to review the concept of "Sight and sound" supervision.

A staff and Children's roster was collected.

An exit interview was conducted and a copy of this report was provided to Site Supervisor, Debora Barajas
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Aaron MabikaTELEPHONE: (661) 305-7599
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: CONCORDIA CHRISTIAN SCHOOL
FACILITY NUMBER: 360910586
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/06/2020
Section Cited

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101229(a)(1) Responsibility for Providing Care and Supervision
No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
This requirement was not met as evidenced by;
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A child got injured and based on interviews the accident was not witnessed by any teacher. The child actually sought help from a teacher.
This poses a direct threat to the health and safety of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Aaron MabikaTELEPHONE: (661) 305-7599
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2020
LIC809 (FAS) - (06/04)
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