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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700600
Report Date: 12/27/2019
Date Signed: 12/27/2019 01:08:59 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:EES-DAVID & JILLIAN GILMOUR EARLY EDUCATIONFACILITY NUMBER:
376700600
ADMINISTRATOR:DARLENE SKIDMOREFACILITY TYPE:
850
ADDRESS:735 AVENIDA DE BENITO JUAREZTELEPHONE:
(760) 639-4170
CITY:VISTASTATE: CAZIP CODE:
92083
CAPACITY:102CENSUS: 45DATE:
12/27/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:37 AM
MET WITH:Darlene Skidmore-AdministratorTIME COMPLETED:
01:15 PM
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A case management visit is being conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 12/20/19. It indicates child #1 reported to their authorized representative that they were pushed by their teacher Staff #1 and stated their ear was pulled by their teacher (Staff #1).

Facility records were reviewed and children and staff were interviewed. Based on information gathered, the facility acted appropriately and no violations have been identified. The facility contacted licensing to report the information received from the parent regarding the UIR within 7 days.

An exit interview was conducted and a copy of this report was provided to the Director Darlene Skidmore.

SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Lakesha EdwardsTELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2011
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2019
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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