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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364808202
Report Date: 02/03/2022
Date Signed: 02/03/2022 05:16:32 PM

Document Has Been Signed on 02/03/2022 05:16 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:WATER OF LIFE PRESCHOOLFACILITY NUMBER:
364808202
ADMINISTRATOR:NORMAN, LESLIEFACILITY TYPE:
850
ADDRESS:7625 EAST AVENUETELEPHONE:
(909) 463-3915
CITY:FONTANASTATE: CAZIP CODE:
92336
CAPACITY: 149TOTAL ENROLLED CHILDREN: 149CENSUS: 58DATE:
02/03/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Gloria Cesena Assistant Director TIME COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Diana Brasel arrived at the facility at the above noted time. A case management visit is being conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was phoned in to the duty officer on the date of the injury 01/19/2022, a completed LIC 624 was submitted on 01/26/22 and entered on 01/27/2022. On the above noted date and time, LPA checked in with the front office area. LPA was advised that the assistant director had stepped out for a moment and would return shortly. LPA was greeted a staff member and taken to the class room that the injured child attends, (C1) was not in care at time of visit. LPA conducted a tour of the facility, took a census, and inspected to outdoor playground where the incident took place. The assistant director returned upon completion of the census, LPA discussed the purpose of the visit and the reported UIR. Interviews were conducted and information gathered during this visit. The following was reported.

On 01/19/2022 at about 9:15 am C1 was playing on the purple dinosaur on the preschool playground. C1 fell off the dinosaur onto the wood chips and landed on their left elbow. S1 observed C1 holding their elbow while lying on the wood chips. At time of injury there were 11 children on the portion of the outside playground with wood chips, with two staff supervising the children. The child was immediately attended too, ice was applied to the child's elbow and parent was called to come to the school. Parent took the child to urgent care, it was reported to staff that C1 sustained a fractured elbow and was put into a cast. The child was released to return to school on Friday, 01/21/2022. Additional safety precautions have been implemented for the purple dinosaur and children are reminded daily of safety rules.

Based on information gathered, there appears to be no violations of Title 22 Regulations found at this time. An exit interview was conducted, and a copy of this report was provided to Assistant Director Gloria Cesena.

No deficiencies were cited during this inspection and a Notice of Site Visit was issued and shall remain posted for 30 days.

Gilbert Sena
Diana Brasel
DATE: 02/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2022
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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