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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421711813
Report Date: 06/05/2019
Date Signed: 06/05/2019 02:08:15 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:SBCEO - DE COLORES STATE PRESCHOOLFACILITY NUMBER:
421711813
ADMINISTRATOR:JANELLE WILLISFACILITY TYPE:
850
ADDRESS:501 NORTH "W" STREETTELEPHONE:
(805) 742-2455
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:28CENSUS: 22DATE:
06/05/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Silvia Hernandez TIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Ruth Gull made an unannounced CASE MANAGEMENT visit to the center. Met with Silvia Hernandez, Site Supervisor to follow up on an incident that was self-reported on 05/03/19. LPA inspected the area where the incident occurred and interviewed Site Supervisor and Teacher #1.

The incident occurred on 05/01/19 at approximately 10:30am on the playground. Child #1 was playing in the sandbox. A portable water pump (which is used for water play) was sitting on the sidewalk next to the sandbox (it had not been used at the time of the incident). Child #1 had been going back and forth from the sandbox to the sidewalk. While Child #1 was on the sidewalk, she slipped, fell and hit the back of her head on the edge of the metal water pump barrel, sustaining a cut to the back of her head. Teacher #1 heard Child #1 cry out and immediately went to her. Teacher #1 administered 1st Aid and took Child #1 to the School nurse. The nurse cleaned Child #1's wound and applied ice. Child #1's parent was notified, arrived and took Child #1 to the hospital emergency room. Child #1 was prescribed an ointment. Child #1 had a follow up appointment with their doctor on 5/02/19 (no additional treatment was needed) and did not attend program that day. Child #1 returned to program on 5/03/19. Staff moved the portable water pump (from the current location where it had always been) to the garden area (grass/dirt area). There were 21 children present with Ms. Hernandez and 2 teachers at the time of the incident.

No deficiencies were cited during today's inspection.

The LIC 9213 (Notice of Site Visit) was posted.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Ruth GullTELEPHONE: (805) 895-4073
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2019
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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