<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406206830
Report Date: 02/24/2022
Date Signed: 02/24/2022 03:28:37 PM


Document Has Been Signed on 02/24/2022 03:28 PM - 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:SAN LUIS OBISPO CHILD DEVELOPMENT CENTERFACILITY NUMBER:
406206830
ADMINISTRATOR:MICHELLE HOLMFACILITY TYPE:
850
ADDRESS:1720 BISHOP ST.TELEPHONE:
(805) 544-0801
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93401
CAPACITY:83CENSUS: 33DATE:
02/24/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Kali ColeckTIME COMPLETED:
03:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 2/24/22, Licensing Program Analyst (LPA) Elvin Baddley contacted an unannounced Case Management inspection of the abovementioned Child Care Center (CCC), to follow up on the report of an Unusual Incident Report (UIR) received by the Department on 2/11/22. Specifically, a child in care, herein C1, fractured collar bone after falling from a step on a play structure in the CCC's outdoor play area. It should be noted, C1 was walking down the play structure steps when the incident occurred. LPA met with Kali Coleck, Program Manager of the CCC and explained the nature of the inspection. LPA notes 33 children are on site along with 13 teachers providing care and supervision.

LPA and Program Manager viewed the play structure where C1 fell. LPA notes the play structure is age appropriate and the footing under the structure has ample cushioning material (i.e. wood chips and cushion mat) to absorb falls. Program Manager notes a total of four staff were in proximity of the play structure when the incident occurred.

LPA notes C1 is currently attending the CCC and has a mesh shoulder sling on the injured area. Staff report C1 has no prolonged issues related to the injuries.

Based on observations and the interview with the Program Manager it is determined neither the equipment at the CCC nor the actions of the CCC's staff contributed to C1's incident. LPA best categorized the incident as an accident.

There were no deficiencies cited during today's inspection.

A notice of site visit was given and must remain posted for 30 days.Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Program Director Kali Coleck.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 02/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/24/2022
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 1