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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004208
Report Date: 04/04/2024
Date Signed: 04/04/2024 02:45:00 PM


Document Has Been Signed on 04/04/2024 02:45 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:IMAGINATION STATION (INF)FACILITY NUMBER:
414004208
ADMINISTRATOR:AGUIRRE, RAELIFACILITY TYPE:
830
ADDRESS:280 - 92ND STREETTELEPHONE:
(650) 746-8356
CITY:DALY CITYSTATE: CAZIP CODE:
94015
CAPACITY:11CENSUS: 6DATE:
04/04/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Raeli AguirreTIME COMPLETED:
03:20 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 April 4, 2024 at approximately 1:20pm, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, case management visit to Imagination Station in regards to an incident that was self-reported March 25, 2024. LPA met with director, Raeli Aguirre, and explained the purpose of the visit.

Facility is a combination center with an infant program and a preschool program. Under the infant license, present during LPA's visit included 6 infants with 3 teaching staff. Under the preschool license, present during LPA's visit included 49 preschool children with 5 teaching staff. During LPA's visit, preschool children were napping.

On March 18, 2024, Teacher 1 (T1) and Teacher 2 (T2) were present in infant classroom with 8 infants. Per director, at approximately 4:30pm, T1 and T2 were preparing infants to transition from infant classroom to outside play time. Per director, a staff member knocked on the outside of the door to the infant yard to receive used dishes from infant classroom.

T1 opened door to infant yard and Child 1 (C1) placed their hand in door jamb. As C1's hand remained in door jamb, the door closed on C1's hand. Per director C1's hand was red and was provided first aid by infant teaching staff. C1's parents were notified of incident on same date. C1 was brought to a medical professional on same date of incident by C1's parents.

Since incident, door jamb "pinch guards" were installed on all infant and toddler classroom doors. Director held a staff meeting in regards to incident, implementing a new protocol of transition periods. Per director, facility's protocol includes multiple staff members having to be present during any transition period.

During today's visit, LPA observed door jam guards installed on infant doors and obtained incident documentation from director. As of this date, C1 has not been diagnosed with any injury from incident. C1 has since returned to facility as of March 25, 2024. Per director, C1 is as per their normal.

No deficiencies were issued during today's visit. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with facility representative, Raeli Aguirre.
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina QuimboTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2024
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