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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700600
Report Date: 12/16/2019
Date Signed: 12/16/2019 11:39:08 AM

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: 81DATE:
12/16/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Darlene SkidmoreTIME COMPLETED:
10:45 AM
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A case management visit is being conducted in response to the receipt of an Unusual Incident (UIR) from the facility. The Unusual Incident Report was received by the Licensing Agency on 11/25/19. LPA met with Darlene Skidmore, Director. It indicates on the Unusual Incident Report, dated 11/21/19, it was reported a child was playing and bumped his head.
It was disclosed, the child was playing on the floor and bumped his right forehead on the table. The staff applied first aid to the child. The parent was notified. There was appropriate teacher/child ratio and supervision.

LPA conducted interviews. Based on the information obtained, there is not a preponderance of evidence to support the occurrence of the alleged incident. From information gathered, the facility acted appropriately and there are no violations that have been identified.

An exit interview was conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Telma SandovalTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Yolanda JacksonTELEPHONE: (951) 201-1991
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2019
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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