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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700600
Report Date: 11/05/2019
Date Signed: 11/05/2019 02:49:48 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: 80DATE:
11/05/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:18 PM
MET WITH:Marti EtediTIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Ericka Smith conducted a case management visit in response to an independent inspection. LPA met with Mari Etedi, Assistant Director (AD).

The facility failed to report an incident occurred on or around September 9, 2019 where a child threatened to bring a knife to school to harm another child's parent. LPA reviewed children files which did not have any documentation regarding the incident. Upon, request of behavioral logs or other forms of tracking incidents, AD was not able to provide documentation regarding the incident, parent communication, or follow-up. This is a potential risk to the health and safety of the children in care.

LPA advised AD to document incidents, behaviors, and parent complaints. Please see LIC 9102 for additional advisory.

Based on the file review and information gathered, the following violations have been identified: Reporting Requirements 101212(d)(1)(C): Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. (1) Events reported shall include the following:(C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child. continue on page 2...

SUPERVISOR'S NAME: Telma SandovalTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Ericka SmithTELEPHONE: (951) 255-4577
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2019
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 3
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: 11/05/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/06/2019
Section Cited

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...Events reported shall include the following:(C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.


This requirement was not met evident by:
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The facility failed to report an incident occurred on or around September 9, 2019 where a child threatened to bring a knife to school to harm another child's parent. This poses a potential risk to the Health and Safety of the children in care.
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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: Telma SandovalTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Ericka SmithTELEPHONE: (951) 255-4577
LICENSING EVALUATOR SIGNATURE:
DATE: 11/05/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/05/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3
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
VISIT DATE: 11/05/2019
NARRATIVE
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See LIC809D for cited deficiencies of the California Code of Regulations, Title 22, Div. 12.

An exit interview was conducted, appeal rights discussed, and a copy of this report was provided to facility staff.

SUPERVISOR'S NAME: Telma SandovalTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Ericka SmithTELEPHONE: (951) 255-4577
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3