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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421710360
Report Date: 01/07/2022
Date Signed: 01/07/2022 03:17:22 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:PACIFIC CHRISTIAN SCHOOLFACILITY NUMBER:
421710360
ADMINISTRATOR:CALDERWOOD, MAUREENFACILITY TYPE:
850
ADDRESS:3435 SANTA MARIA WAYTELEPHONE:
(805) 938-7555
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY:90CENSUS: 35DATE:
01/07/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Maureen Calderwood and Danielle WhiteTIME COMPLETED:
03:20 PM
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On 1/7/2022, Licensing Program Analyst (LPA) Reyes conducted an unannounced Case Management Inspection and met with Director, Maureen Calderwood. LPA asked pre screening questions related to COVDI -19, director's responses indicate there are no COVID 19 exposure on site. LPA discussed the purpose of the inspection There were 35 children 9 staff present during the inspection.

On 12/22/2021, the above mentioned Child Care Center (CCC) self reported an incident that occurred on 12/21/2021 at or about 9:45 AM. Child 1 complained an arm pain on C1's left arm. CCC notified C1's authorized representative who attributed the pain to C1's history of nursemaid's elbow in the past. C1 was taken to the doctor and C1 was diagnosed of a hairline fracture on C1 left ulna/forearm. C1's left forearm was put on a soft cast for two weeks. Based on the report received, C1 informed parent that C1 fell when playing blocks at school.

LPA interviewed the classroom teacher, Ms. Reiswig. As previously reported, Ms. Reisweg recounted she was on the floor playing with children and did not observe C1 fell. There were 12 students during the playtime. LPA inspected the classroom and observed that toys and equipment in the classroom are safe and age appropriate. It is also noted that surface of the classroom is safe and there are no hazardous items that could cause a fall or pose danger among day care children. During the inspection C1 was not available for interview.

During today's inspection no deficiency was cited. Exit interview conducted with Administrative Assistant, Danielle White. Notice of Site Visit has been posted (LIC9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2022
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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