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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701308
Report Date: 02/12/2020
Date Signed: 02/12/2020 01:16:17 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:MAAC FOOTHILL INFANT CENTERFACILITY NUMBER:
376701308
ADMINISTRATOR:APRIL ANDREOLAFACILITY TYPE:
830
ADDRESS:1410 FOOTHILL DRIVETELEPHONE:
(760) 741-0541
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY:20CENSUS: 13DATE:
02/12/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:58 AM
MET WITH:APRIL ANDREOLATIME COMPLETED:
01:20 PM
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Licensing Program Analyst (LPA) Sean Williams arrived at the facility on a case management inspection to follow-up on an Unusual Incident Report (UIR) submitted to Community Care Licensing (CCL). It was reported that a child was walking the yard play area tripped on their foot and fell causing the child to hit their head on a fence post causing a cut on the right side of their head.

Based on the interviews, observations of the play area, and information obtained during the course of this incident visit, there is no indication that a violation of Title 22 Regulations occurred. Three staff members were present and witnessed the incident take place. Staff seemed to have taken the necessary steps to ensure the child's needs were met during and after the incident took place. The child is currently still enrolled at the facility and was reported as doing fine.

Exit interview conducted and a copy of this report was left at the facility.

A copy of this report must be made available to the public for 3 years.
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Sean R WilliamsTELEPHONE: (951) 204-2046
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2020
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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