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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426205362
Report Date: 10/03/2019
Date Signed: 10/03/2019 04:32:28 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 - LEARNING PLACE STATE PRESCHOOL, THEFACILITY NUMBER:
426205362
ADMINISTRATOR:JANELLE WILLISFACILITY TYPE:
850
ADDRESS:UTAH AVENUETELEPHONE:
(805) 742-2077
CITY:VANDENBERG AFBSTATE: CAZIP CODE:
93437
CAPACITY:26CENSUS: 20DATE:
10/03/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Rebecca ArreolaTIME COMPLETED:
04:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Ruth Gull made an unannounced CASE MANAGEMENT visit to the center. Met with Rebecca Arreola, Interim Site Supervisor to follow up on an incident that was self-reported on 08/22/19. LPA inspected the area where the incident occurred; interviewed Site Supervisor and Staff #1; and reviewed children records.
The incident occurred on 08/21/19 at approximately 12:45pm in the classroom. Child #2 hit Child #1 in the pubic area, causing Child #1 to fall backward landing on the buttocks (Child #2 wanted the toy that Child #1 was holding). Staff did not observe the incident. Staff #1 was standing nearby, but was attending to another child. Ms. Arreola was in another area of the room. Both Ms. Arreola and Staff #1 became aware when they heard Child #1 cry out. Ms. Arreola provided ice to Child #1 to apply to the pubic area. Child #1 then appeared to be fine and resumed normal activities. Child #1's parents were notified. Child #1 remained in program until normal pick up time. On 08/22/19 at approximately 11:45am, when Child #1 arrived, Child #1's parents informed Ms. Arreola that they had observed blood in Child #'1s underwear on the evening of 08/21/19 and had taken Child #1 to the Emergency Room. A doctor examined Child #1, stated that there was superficial trauma and instructed that Child #1 bathe with epsom salts. Child #1 did not require any further medical treatment.
Ms. Arreola met with Child #2's parents. Child #2 is new to the program and had been attending for approximately one week at the time of the incident. Child #2 has had other incidents of hitting but none of the children had injuries that required medical attention. A staff is now designated to be in close proximity to and constantly observe Child #2. There were 17 children with Ms. Arreola, another teacher and Staff #1 at the time of the incident.

Pursuant to Title 22 of the California Code of Regulations, the following Type B deficiency was cited (refer to LIC 809-D). Today's reports were reviewed and issued. The Licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights.
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: 10/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2019
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: SBCEO - LEARNING PLACE STATE PRESCHOOL, THE
FACILITY NUMBER: 426205362
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/10/2019
Section Cited

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101223(2) Personal Rights - To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
This requirement was not met as evidenced by: LPA's review of Unusual Incident Report, children records and interviews with Interim Site Supervisor and Staff #1 reveals that
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Child #1 was hit by Child #2 resulting in superficial trauma to Child #1's pubic area. This poses a potential health and safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Ruth GullTELEPHONE: (805) 895-4073
LICENSING EVALUATOR SIGNATURE:
DATE: 10/03/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2019
LIC809 (FAS) - (06/04)
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