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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 401711736
Report Date: 03/05/2020
Date Signed: 03/05/2020 04:14:37 PM

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:OCEANVIEW ELEMENTARY SCHOOLFACILITY NUMBER:
401711736
ADMINISTRATOR:CARRIE VAN BEVERENFACILITY TYPE:
840
ADDRESS:1208 LINDA DRIVETELEPHONE:
(805) 473-5476
CITY:ARROYO GRANDESTATE: CAZIP CODE:
93420
CAPACITY:84CENSUS: 38DATE:
03/05/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Carrie Van BeverenTIME COMPLETED:
04:25 PM
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On March 2, 2020 at 2:05 PM Licensing Program Analyst (LPA) Martina Jimenez conducted an unannounced Case Management visit and met with Carrie Van Beveren, . The incident report was received by the Department in writing on 3/2/2020 as required.


On 2/25/2020, at approximately 4:30 PM, child 1 was playing on the monkey bars of the play structure. Staff 1 observed child1 hanging upside down on the monkey bars. Staff1 reminded C1 we don’t climb on top of the monkey bars we just go across, then C1 fall off the monkey bars, hitting their head, and landing on their backside with their arm extended out to break the fall. Child #1's parent was advised of the incident and was provided written report of the incident.to the Department on 03/02/2020. C1 returned to care wearing a soft cast. C1 is currently waiting for a hard cast. LPA was advised the children returned to care on 2/27/2020.


No deficiencies cited. LPA observed the "Notice of Site Visit Posted".

FAILURE TO POST THE NOTICE OF SITE VISIT MAY RESULT IN A $100.00 CIVIL PENALTY.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 387-5041
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020
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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