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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421711657
Report Date: 06/13/2023
Date Signed: 06/13/2023 01:50:31 PM


Document Has Been Signed on 06/13/2023 01:50 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:COLUMBIA CHILDREN'S CENTER, INC.FACILITY NUMBER:
421711657
ADMINISTRATOR:CORTNEY DASMANNFACILITY TYPE:
850
ADDRESS:840 EAST STOWELL ROADTELEPHONE:
(805) 922-5437
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:82CENSUS: 65DATE:
06/13/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Cortney DasmannTIME COMPLETED:
12:00 PM
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On 06/13/2023 at 11:00 AM, Licensing Program Analyst (LPAs) Francisca Velazquez and Dixie Wright made an unannounced inspection to address an Unusual Incident Report (UIR) and met with Director, Cortney Dasmann. The Regional Office (RO) received UIR on 06/09/2023. Specifically, LPA was informed that on 06/08/2023, C1 was exiting the classroom while skipping and ran into shelf. C1 hit his lips which caused C1's lip to start bleeding and required medical attention. LPA observed 65 children in care at the time of the inspection.

LPAs toured the playground and observed the area where C1's injury occurred. Director reported that C1's classroom was going to the outdoor playground and as C1 was running out to the playground, he was not paying attention and ran into an outdoor shelf. Director showed LPAs video footage that capture this incident and LPAs observed C1 running into the outdoor shelf. LPAs observed the shelf has cushioning around the edges of the shelf and is kid friendly. Director reported that after C1 ran into the shelf, staff attended to C1 and provided ice to C1's injury. Parents of were notified of incident immediately. Parents picked up C1 and took C1 to receive medical attention where C1 received stitches on the inside and outside of C1's lip.

LPAs attempted to contact parent of C1 but were unable to connect. Director reported that parents received a copy of the video footage capturing incident. Parents did not have any questions or concerns regarding the incident. C1 continues to be enrolled in the facility.

Based on LPAs observations and along with interviews, it was determined the facility actions did not contribute to the incident of C1's injuries. Further, the facility acted in accordance with Title 22 regulations. No deficiencies were cited during today's inspection.

Exit interview was conducted with director, Cortney Dasmann. The Notice of Site Visit was also provided to the facility as required by H&S Code Section 1596.817. The Notice of Site Visit must remain posted for 30 days or a civil penalty of $100.00 may apply.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:
DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2023
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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