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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700040
Report Date: 10/18/2019
Date Signed: 10/18/2019 03:49:16 PM

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:CHILDREN'S ATELIER CENTERFACILITY NUMBER:
376700040
ADMINISTRATOR:ANDREA HERNANDEZFACILITY TYPE:
850
ADDRESS:1508 WINDSOR ROADTELEPHONE:
(760) 942-3240
CITY:CARDIFF BY THE SEASTATE: CAZIP CODE:
92007
CAPACITY:52CENSUS: 17DATE:
10/18/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Director Andrea HernandezTIME COMPLETED:
03:55 PM
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Licensing Program Analyst, Joelle Redding, made an unannounced visit to evaluate a self-reported incident that occurred on 10/4/19 wherein a 4 year old child (Child #1) jumped off the end of the slide, sustaining an injury to the forearm requiring medical attention.

LPA spoke with Director and Staff #1 who were on the playground at the time of the incident. Staff #2 who witnessed the incident is no longer with the facility. LPA obtained contact information for follow up. Director states that she was standing on the other side of the play structure when the incident happened. Child #1 did not cry right away but started to about 5 to 10 minutes after the incident. Staff #1 stated that she had been with another child who needed to use the restroom and saw Child #1 crying on the ground. She stated that she picked him up and asked him what happened. He told her that his arm hurt and pointed to his forearm up near the elbow. Initially when assessed, there was no swelling and he had movement in his arm, but shortly thereafter, Child #1 started to cry harder and swelling was noticed in the area he had pointed to earlier. Parent contact was made for pick up. The facility states that Child #1 was taken to the doctor and his parent provided a doctor's note that he was able to return to school on 10/9, the day after his appointment. However, Child #1 has not returned because he is still in pain, according to his father. The facility has provided clinics for further treatment but no further documentation has been provided on his injury. Director and Staff #1 state that the policy for the slide is that one child is allowed down at a time and there is always a staff member at the bottom of the slide to supervise. Director stated that Staff #2 told her that Child #1 had slid down the slide the proper way then stood up when he got to the bottom. Staff #2 told him to sit down but he jumped over the side before she could stop him. LPA examined the slide. It is age appropriate with the end is just about a foot from ground. The cushioning around the play structure and slide is sufficient for impact. The ratio on the playground at the time was approximately 1:6, supervision was in place, facility staff responded appropriately and the facility reported timely.

No deficiencies are cited today.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2019
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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