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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364843546
Report Date: 04/20/2022
Date Signed: 04/25/2022 08:45:45 AM


Document Has Been Signed on 04/25/2022 08:45 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:VILLANUEVA FAMILY CHILD CAREFACILITY NUMBER:
364843546
ADMINISTRATOR:VILLANUEVA, ROCIOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 492-3148
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY:14CENSUS: 5DATE:
04/20/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Rocio VillanuevaTIME COMPLETED:
11:00 AM
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On this date and time, Licensing Program Analysts (LPAs) Laura Mejorado and Aman Sharma conducted an unannounced case management inspection to follow-up on an Unusual Incident Report (UIR) submitted by the facility to the Riverside Child Care Regional Office on 04/14/22. During this inspection, LPA met with Licensee Rocio Villanueva and discussed the following:

It was reported on 04/13/22 a child was outside playing and tripped while running down a ramp. The child fell landing on their right side and began to cry. The Licensee’s assistant helped the child however did not notice any cuts or scratches due to the child wearing a coat. It was not until another assistant was helping the child wash their hands, they notice the child’s right arm was in pain. At this point the Licensee took the child’s jacket off and examined their right arm. Licensee noticed the child could not grab things with their right hand and contacted both parents informing them of what happened. The child was picked up by their parent and taken to urgent care where the child was diagnosed with a dislocated elbow. The child recovered at home and returned to the facility on 04/18/22. After the incident the Licensee installed a gate at the end of the ramp to prevent any children from running down.

At this time based on information obtained during the inspection, as well as an inspection of the area where the reported incident occurred, there appears to be no violations of Title 22 Regulations at this time.

An exit interview was conducted with Licensee Rocio Villanueva, and a Notice of Site Visit was provided and must be posted for 30 days.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Laura MejoradoTELEPHONE: 951-782-4200
LICENSING EVALUATOR SIGNATURE:
DATE: 04/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2022
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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