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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700600
Report Date: 07/05/2022
Date Signed: 07/05/2022 02:59:37 PM


Document Has Been Signed on 07/05/2022 02:59 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:EES-DAVID & JILLIAN GILMOUR EARLY EDUCATIONFACILITY NUMBER:
376700600
ADMINISTRATOR:SARA SALAZARFACILITY TYPE:
850
ADDRESS:735 AVENIDA DE BENITO JUAREZTELEPHONE:
(760) 639-4170
CITY:VISTASTATE: CAZIP CODE:
92083
CAPACITY:102CENSUS: 29DATE:
07/05/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Sara SalazarTIME COMPLETED:
03:05 PM
NARRATIVE
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On the date and time listed above, Licensing Program Analyst (LPA) Jessica Rubio arrived announced to investigate an unusual incident report dated 5/20/2022 describing a child (C1) waking up from a nap vomiting and shaking. LPA requested and reviewed documents and interviewed Director of Program & Operations Sara Salazar, and two staff (S1 & S2) who were present in the classroom when the incident with C1 occurred. Based on confidential interviews conducted it was revealed that C1 had foaming saliva coming from C1’s mouth, and appeared to be choking. It was also revealed during this time C1 was unresponsive and limp while staff was attending to C1 and C1’s color was also purple. It was revealed that from the time C1 was vomiting/choking to when C1 woke and became responsive was approximately 3-5 minutes. After C1 became responsive and was crying, it was revealed C1’s left side of their body was still limp, C1’s eye was twitching and C1 could not close their mouth. The facility contacted C1’s parent to tell them about the incident and C1’s parent arrived to take C1 for medical attention. At no time during the incident or after did the facility contact Emergency Medical Services for C1. The facility is being cited for Title 22 Regulation Section 101226 (c) Health Related Services.

A copy of this report was provided to Director. The Notice of Site Visit and Type A Deficiency from today’s visit must be posted for 30 days. Failure to keep these posted for the entire 30 days will result in an immediate $100 civil penalty for each.

An exit interview was conducted, appeal rights were discussed and given to the Director of Program & Operations Sara Salazar along with a copy of LIC 9224 (AB 633).

SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 255-4093
LICENSING EVALUATOR NAME: Jessica M RubioTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:
DATE: 07/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/05/2022
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 2


Document Has Been Signed on 07/05/2022 02:59 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 EDUCATION
FACILITY NUMBER: 376700600

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/06/2022
Section Cited

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Health Related Services. The licensee shall obtain emergency medical treatment...if the...child's illness or injury is such that there should be no delay in getting medical treatment for the child. This requirement was not met as evidenced by:
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Based on interviews, the facility did not contact Emergency Medical Services when C1 had an unusual incident where C1 appeared to be choking, was unresponsive and appeared discolored.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 255-4093
LICENSING EVALUATOR NAME: Jessica M RubioTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:
DATE: 07/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/05/2022
LIC809 (FAS) - (06/04)
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