<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376625066
Report Date: 11/15/2019
Date Signed: 11/15/2019 02:10:55 PM

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:FERRER, MARIA DE LOURDES FAMILY CHILD CAREFACILITY NUMBER:
376625066
ADMINISTRATOR:MARIA DE LOURDES FERRERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 294-2056
CITY:ESCONDIDOSTATE: CAZIP CODE:
92027
CAPACITY:14CENSUS: 6DATE:
11/15/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Daisy Saldana, AssistantTIME COMPLETED:
12:45 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
Licensing Program Analyst (LPA) Mariah McCarty made an unannounced visit to the facility and met with Maria De Lourdes. A case management visit was conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on November 1, 2019. It indicated a child was outside playing on the playground’s logs and tripped and hit her head and sustained a cut on October 24, 2019.

Facility records were reviewed, and assistant and children were interviewed. Based on information gathered, and the LPA's inspection of the backyard play area there were not any safety hazards present and the facility acted appropriately, therefore no violations have been identified at this time.

SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Mariah McCartyTELEPHONE: (951) 255-4093
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1