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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700698
Report Date: 10/06/2021
Date Signed: 10/06/2021 11:32:16 AM

Document Has Been Signed on 10/06/2021 11:32 AM - 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:NORTH COAST CHURCH PRESCHOOLFACILITY NUMBER:
376700698
ADMINISTRATOR:MARCIA BOECHEFACILITY TYPE:
850
ADDRESS:2405 NORTH SANTA FE AVENUETELEPHONE:
(760) 330-9200
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY: 165TOTAL ENROLLED CHILDREN: 0CENSUS: 79DATE:
10/06/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:42 AM
MET WITH:Marcia BoecheTIME COMPLETED:
11:40 AM
NARRATIVE
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Licensing Program Analyst (LPA) Jeanette Sanchez made a case management visit in response to the receipt of an Unusual Incident Report (UIR) from the facility. The UIR was received by the licensing agency on 9/29/2021. It indicates that on 9/24/2021, a child was standing on the bottom rail of a lodge pole, lost balance and fell from the lodge pole fence. LPA met with Director Marcia Boeche, for an interview to discuss the incident.

Director explained that she was not present when the incident occurred and submitted the UIR based on the information received. However, upon reviewing video of the play yard, the Director noticed that the child was trying to sit on the top rail of the lodge pole fence when the child fell backwards. The child landed with the right arm behind the back, causing a break of the elbow. LPA reviewed the video and observed the area where the incident occurred. The fence was found to be 2 feet tall, with two horizontal rails. A teacher was approximately 34 feet away, observing all children. The video shows there was about 10 seconds from the fall to the teacher coming into frame of the video. Teacher is seen already observing the situation while approaching the child.

Director stated has discussed with staff that children should not sit on top of the lodge pole fences and will also remind staff to allow children to only play on playground equipment.

A Technical Assistance Advisory Note was issued.

An exit interview was conducted, appeal rights discussed, and a copy of this report was provided to the Director.
SUPERVISORS NAME: Stephanie Hudak
LICENSING EVALUATOR NAME: Jeanette Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2021
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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