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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 401711246
Report Date: 06/13/2019
Date Signed: 06/14/2019 09:03:16 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:CHILD'S SMILE PRESCHOOLFACILITY NUMBER:
401711246
ADMINISTRATOR:SHIRLEY ALBRECHTFACILITY TYPE:
850
ADDRESS:781 PAUL PLACETELEPHONE:
(805) 481-4814
CITY:ARROYO GRANDESTATE: CAZIP CODE:
93420
CAPACITY:28CENSUS: 15DATE:
06/13/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Kristin SalazarTIME COMPLETED:
02:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced Case Management Inspection and met with Director, Kristy Salazar. There were 15 children and 3 teachers present, children were napping when LPA arrived. The purpose of the visit was discussed. Owner/Director Shirley Albrecht came after 30 minutes.

The inspection was regarding the incident that occurred on June 3, 2019 around 11:15 AM. Based on LPA's interview with Teacher 1, Child 1 bit Child 2. Child 1 was holding a piggy bank when child 2 wrapped Child 2's arm around Child 1. Staff 1 saw the incident and separated the 2 children. Child 1 continued putting away the piggy bank in the shelf when Child 2 ran back to Child 1 from behind and reached for the toy again. Child 1 turned around and bit Child 2. Staff 1 saw Child 2 dropped to the ground and started crying. Staff 2 who was in the other corner of the room attending to another child saw the incident and immediately called Staff 1's attention who was closer to Child 1 and Child 2. Staff 1 was not able to prevent the incident from happening because Staff 1 was tying another child's shoe lace. On the day of the incident, there were 9 children in the play room with Staff 1 and Staff 2.

In the course of the interview, Staff 1 mentioned that Child 1 bit another Child, (Child 3) the following day, June 4, 2019. The said incident was not reported to CCLD.

During today's inspection, deficiency was cited under Title 22 Division 12. Appeal Rights Given.
LPA observed Owner/Director posted the Notice of Site visit.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2019
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: CHILD'S SMILE PRESCHOOL
FACILITY NUMBER: 401711246
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/24/2019
Section Cited
CCR
101212(d)(1)(C)
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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
(1)(C)Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.
This requirement is not met as evidenced by:
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Licensee/Owner agreed to submit an incident report regarding the 6/4/2019 incident and will ensure to report any unsual incident that threatens the physical and emotional health and safety of any child.
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Based on LPA's interview with Staff 1, Staff 1 stated that Child 1 bit another child (Child3) the following day 6/4/2019 after the 6/3/2019 incident. The incident was not reported to CCLD. This poses a potential risk to health and safety of 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: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2019
LIC809 (FAS) - (06/04)
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