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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600676
Report Date: 10/11/2022
Date Signed: 10/11/2022 01:11:17 PM


Document Has Been Signed on 10/11/2022 01:11 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 STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:CASA DE NINOS CHILD DEVELOPMENT CENTERFACILITY NUMBER:
376600676
ADMINISTRATOR:TERRAZAS, NORMAFACILITY TYPE:
850
ADDRESS:1718 MISSION AVENUETELEPHONE:
(760) 757-3207
CITY:OCEANSIDESTATE: CAZIP CODE:
92054
CAPACITY:119CENSUS: 56DATE:
10/11/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Norma TerrzasTIME COMPLETED:
01:20 PM
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A case management visit is being conducted by Licensing Program Analyst (LPA) Jamex Wilkerson in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 09/22/22. It indicates that a child was climbing down a play structure and upon see his/her parent arrive at the gate, to excited and missed a rung, slip and hit his/her cheek. The child was interviewed and stated that this teacher saw what happened. A staff member was also interviewed and stated that the incident was observed, but it happened too quickly to prevent it from happening..

Based on information gathered, the facility acted appropriately and no violations have been identified.

An exit interview was conducted and a copy of this report was provided to facility staff.
SUPERVISOR'S NAME: Carlos MartinezTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: James WilkersonTELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2022
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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