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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370805052
Report Date: 08/30/2021
Date Signed: 08/30/2021 11:48:57 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:WOW CHRISTIAN PRESCHOOLFACILITY NUMBER:
370805052
ADMINISTRATOR:SALLY GUTIERREZFACILITY TYPE:
850
ADDRESS:9140 AKARD STREETTELEPHONE:
(619) 267-0885
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY:51CENSUS: 15DATE:
08/30/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Sally GurierrezTIME COMPLETED:
12:00 PM
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On August 30, 2021 at 11:30am, Licensing Program Analysts (LPAs) David Miller and Martha Malane, conducted an unannounced case management inspection in response to an unusual incident report (UIR) regarding a 4-year old child who had a bean removed from her ear. The facility self-reported the incident to the Department on 07/20/2021. The facility reported the following: Child was picked up from school on 07/20/2021 at 4:35pm. After child got home, child was complaining of her ear hurting and said that she put a bean in her ear while at the facility. Child was taken to Children’s Hospital to extract the bean in the ear. At the time of the incident, there were ten (10) children being supervised on the playground by two (2) staff members,

Interviews were conducted with the Center Director, staff members, parents and children in care. According to staff members, on the playground there is a tree with flowers and it drops pods that look like brown beans. Child in question confirmed she put a bean in her ear while playing on the playground. LPA conducted an inspection of the play yard for health and safety and did not observe any tripping hazards or safety issues in the play yard during the inspection. LPA confirmed that the bean the child put in her ear fell from the tree as evidenced by noting a few bean pods on the ground that looked like the same bean from the initial photo taken on the day of the incident. Appropriate care and supervision including staff ratio were observed during today’s inspection. Based on interviews, it was determined this incident was accidental. The Director provided the following plan: inform children daily not to put objects they find on the ground, including the tree beans, into their mouths, nose, or ears. The Director further stated that the plan includes sweeping and cleaning below the tree area daily and prior to any outdoor play.

No deficiencies cited during today’s inspection. A copy of this report and appeal rights (LIC 9058) was printed and given to the Director. Director was advised to post the LIC 9213 for 30 days. An exit interview was conducted with the director.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha MalaneTELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021
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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