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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421710360
Report Date: 03/21/2022
Date Signed: 03/21/2022 01:39:17 PM


Document Has Been Signed on 03/21/2022 01:39 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: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: 73DATE:
03/21/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Maureen Calderwood and Sonja WittliebTIME COMPLETED:
10:20 AM
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On 3/21//2022 at 8:50 AM, Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced Case Management Inspection. LPA Reyes asked pre screening questions related to COVID 19, Assistant Director's responses indicate there are no COVID -19 exposure on site. LPA met with Assistant Director and explained the purpose of the inspection. There were 73 children and 11 teachers present. LPA toured the Child Care Center (CCC) in the company of the Assistant Director. Director Maureen Calderwood was conducting children's evaluation when LPA arrived.

On 2/11/2022, Child Care Center (CCC) self reported an incident which occurred on 2/11/2022 on or about 10:30 AM. Based on the Unusual Incident Report (LIC624), Child # 1 sustained injury on C1's right pointer and left ring finger when C1 tripped on the art cart while in the restroom.

On 3/21/2022, LPA Reyes interviewed Staff # 1 who stated S1 did not witness the incident however S1 who was passing by the bathroom door heard C1 cried and immediately attended to C1. S1 stated there was another staff who monitors/supervises children going to the restroom. LPA interviewed Child no 1 (C1), C1 recounted that C1 tripped on the art cart and tried to hold onto the cart which caused the cut on C1's 2 fingers. C1 stated C1 cannot remember who was in the bathroom at the time of the incident. CCC Staff applied first aid, contacted parents. C1's injury required a medical treatment where band aid was applied. Directror Maureen Calderwood stated there are 2 to 3 staff in the activity/common area to physically and visually supervise children when they use the restroom. During the inspection, LPA observed day care children are accompanied in going to the restroom, it was also noted that the art card was moved out of the restroom.

During today's inspection, Technical Assistance on care and supervision was issued, no deficiencies were cited. A notice of site visit was given and must remain posted for 30 days.Exit interview conducted and report was reviewed with Director Maureen Calderwood.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:
DATE: 03/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2022
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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