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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700600
Report Date: 05/25/2023
Date Signed: 05/25/2023 04:46:39 PM


Document Has Been Signed on 05/25/2023 04:46 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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:EES-DAVID & JILLIAN GILMOUR EARLY EDUCATIONFACILITY NUMBER:
376700600
ADMINISTRATOR:KELLY GERTHFACILITY TYPE:
850
ADDRESS:735 AVENIDA DE BENITO JUAREZTELEPHONE:
(760) 639-4170
CITY:VISTASTATE: CAZIP CODE:
92083
CAPACITY:102CENSUS: 34DATE:
05/25/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Kelly GerthTIME COMPLETED:
05:00 PM
NARRATIVE
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On May 25, 2023 at 2:30 pm, Licensing Program Analyst (LPA) William Chancellor conducted a case management visit at EES- David and Jillian Gilmour Early Education Campus (CCC) due to an unusual incident report received for an incident that was reported on 5/8/2023, reporting that child (C1) required medical attention due to falling on their arm after slipping on the lower part of the school playground. LPA met with and interviewed Director (AD) Kelly Gerth and conducted a tour of the facility. During the visit, LPA conducted interviews with child 1 (C1) and one staff (S1) who were present on the playground when the incident occurred. Interviews revealed the staff were in ratio at the time of the incident and S1 observed C1 fall. Staff 2 was not present for questioning on today’s date of case management visit. Staff provided appropriate first aid and notified C1's parents of the incident however, the accident could have been prevented if the surface was free of hazards and sand.

LPA determined the facility is in violation of Title 22 Regulation Section 101238.2 (c) Outdoor Activity Space.


Equipment and activity areas shall be arranged so that there is no hazard from conflicting activities.
Due the grass field abruptly ending at a slanted sandy hill, this has become a highly hazardous area where the risk is greater for children to get injured. Ultimately resulting in C1 requiring medical attention.

A citation will be issued.

An exit interview was conducted, a copy of this report, LIC 811 (Confidential Names List) and appeal rights were reviewed with and provided to Director Kelly Gerth. A notice of site visit will be provided and must remain posted for 30 days.

SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: William M Chancellor Jr.TELEPHONE: 951-970-1388
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2023
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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Document Has Been Signed on 05/25/2023 04:46 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
RIVERSIDE SOUTH EAST, 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: 05/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/09/2023
Section Cited
CCR
101238.2(c)

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Outdoor Activity Space. (c)
Equipment and activity areas shall be arranged so that there is no hazard from conflicting activities.
C1 fell and broke arm, requring medical attention due to the uneven surfaces abruptly transitioning on the playground. which poses a potential health, safety or personal rigths risk to children in care.
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Director will email LPA Chancellor photos of a permanent fence seperating the sand area from the grass field.

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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) 782-6641
LICENSING EVALUATOR NAME: William M Chancellor Jr.TELEPHONE: 951-970-1388
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2023
LIC809 (FAS) - (06/04)
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