364815848-6-21-2023-09-CC-JGIE-CSZPSV-20230621113458

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364815848
Report Date: 06/13/2023
Date Signed: 06/21/2023 11:35:02 AM

Document Has Been Signed on 06/21/2023 11:35 AM - 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:	KIDZ ROCK CHILDREN'S LEARNING CENTER		FACILITY NUMBER:	364815848
ADMINISTRATOR:	CASTRO, STEPHANIE		FACILITY TYPE:	850
ADDRESS:	2345 S. WATERMAN AVENUE		TELEPHONE:	(909) 264-2000
CITY:	SAN BERNARDINO	STATE: CA	ZIP CODE:	92408
CAPACITY:	99	CENSUS: 37	DATE:	06/13/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Stepahnie Castro		TIME COMPLETED:	03:35 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 06/13/2023 at time listed above Licensing Program Analysts (LPA) Justin Giese conducted an unannounced visit to the facility to follow up on the submission of an Unusual Incident Report (UIR) that was received by the Regional Office on 06/06/2023 and processed on 06/12/2023. LPA met with Facility Director, Stephanie Castro, to discuss the purpose of the visit. On June 06, 2023, Facility Staff self reported an incident where a child in care sustained an injury on the playground. UIR stated that around 08:40am a child was navigating the steps of play structure. The turned to slide down the edge, caught their foot and fell forward off the steps, landing in the wood chips. The child that fell was observed to favor their right wrist and complained of pain afterwards. UIR stated the fall was witnessed by facility staff as it had occurred. Staff immediately went to the child, assessed their condition and administered an ice pack. The parent/guardian of the child was contacted, and the child was picked up shortly after incident. UIR stated the parent/guardian contacted the facility the following day to inform that the child had been seen by a physician and it was determined they sustained a fracture on their right wrist. The child was given an arm cast and returned to the facility on Monday, 06/12/2023 with no restrictions. At time of this visit, LPA toured the facility playground where the incident had occurred. In addition, LPA interviewed the child and staff involved in this incident. While touring the playground and play structure area, LPA was shown by staff where and how the incident occurred. LPA observed a set of steps that lead to the top of the play structure. It was stated by staff that the child was going up the steps, lost there footing and fell midway up the steps onto the wood chips below. Staff stated the fall was accidental and no other children were involved.

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Justin Giese	TELEPHONE: (951) 204-4847
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023

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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KIDZ ROCK CHILDREN'S LEARNING CENTER	FACILITY NUMBER: 364815848
	VISIT DATE: 06/13/2023

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LPA interviewed the child involved in this incident. Statements recorded from the child and staff corroborate statements the child was climbing the steps, lost their footing and fell. Going forward, staff stated they have been monitoring this area of the play structure more closely to assure that children do not slip/fall while on the steps. Staff stated they have reminded all the children in care to be mindful of their balance and foot position while climbing the steps of the play structure.

Statements recorded form interviewing all parties involved revealed the fall was accidental in nature. Based on LPA observations and interview there appear to be no violations of Title 22. Facility staff were present and quick to aid the child after the fall. Parent/guardian was notified immediately, and the Facility fulfilled its reporting requirements to Licensing.

An exit interview was conducted, LPA provided Facility Director with a copy of this report and a notice of site visit on 06/13/2023.

Notice of site visit must be displayed for the next 30 days.

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Justin Giese	TELEPHONE: (951) 204-4847
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023

LIC809 (FAS) - (06/04)

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