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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215542
Report Date: 07/12/2024
Date Signed: 07/12/2024 02:58:49 PM


Document Has Been Signed on 07/12/2024 02:58 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:SIZEMORE FCC AKA LEARNING LADDER CHILDCAREFACILITY NUMBER:
406215542
ADMINISTRATOR:KEISHA SIZEMOREFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 674-7621
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY:14CENSUS: 10DATE:
07/12/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Keisha SizemoreTIME COMPLETED:
03:15 PM
NARRATIVE
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On 7/12/2024 at 1:30 PM, Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced Case Management inspection regarding the self reported incident which occurred on 6/24/2024. LPA met with Licensee, Keisha Sizemore and Assistant Karri Slane. LPA explained the nature of the inspection.

LPA and Licensee toured the home including the outdoor play area where the incident occurred. There were 8 children present, 2 of whom were infants. Per the unusual incident report, on 6/24/2024 around 10:00 AM, 5 children and Assistant Karri Slane were outside playing. Child # 1 and Child #2 were playing with an 8 inch plastic stool, turned upside down and putting rubber mulch in it, then placed a basketball and another similar stool on top of the upside down stool fitting perfectly. Despite the warning Child # 1 stepped on the stool, it tilted causing the child to fall forward on the rubber mulch landing on Child # 1's left arm.

LPA interviewed the assistant who showed LPA where she was standing when the incident occurred. Assistant was in the position where she could see all the children playing in the backyard. The assistant could not prevent the fall because she was 8 feet away supervising other children but she witnessed the entire incident.

Continued on LIC 809C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2024
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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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: SIZEMORE FCC AKA LEARNING LADDER CHILDCARE
FACILITY NUMBER: 406215542
VISIT DATE: 07/12/2024
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LPA also observed checked that the plastic stool is age appropriate, the backyard surface is covered with rubber mulch and free of any hazardous item.
Licensee stated she was with the other 5 children inside the home doing projects.

After the incident, Assistant and Licensee comforted the child, applied ice on it, and notified parent. Child was found to have sustained a buckle fracture. The child was given a brace to wear for 3 weeks. Child was kept home the following day after the incident, 6/25/2024 and returned to FCCH on 6/26/2024.

Child # 1 does not come to day care on Fridays, thus child # 1 was not present at the time of the inspection.

During today's inspection, no deficiency was cited,

Notice of Site Visit was issued and must remain posted for 30 days,

Exit interview conducted and report was reviewed with licensee Keisha Sizemore.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2024
LIC809 (FAS) - (06/04)
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