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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426207705
Report Date: 12/04/2019
Date Signed: 12/04/2019 01:30:31 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:ORFALEA CHILDREN'S CENTER LAB SCHOOL AT AHCFACILITY NUMBER:
426207705
ADMINISTRATOR:YVON FRAZIERFACILITY TYPE:
830
ADDRESS:800 SOUTH COLLEGE DRIVETELEPHONE:
(805) 922-6966
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:24CENSUS: DATE:
12/04/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Maria SuarezTIME COMPLETED:
01:35 PM
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Licensing Program Analyst (LPA) Melissa Stewart made an unannounced visit for the purpose of conducting a Case Management inspection. LPA met with Director Maria Suarez and discussed the nature and purpose of the visit.

On 11/21/19 an incident occurred at the facility with a child in care which called for medical attention.
At 9:15 am, a child (C1) was sitting on a couch and another child (C2) was sitting in front of C1 on the floor. Child 2 grabbed Child 1's left wrist and pulled C1's left arm behind C1's head. Staff (S1) observed the incident, picked up C1. S1 reported that C1 did not cry until after S1 put C1 back down onto the floor. S2 applied ice to C1's left wrist. C1's mother was immediately contacted. The child's mother took child to primary doctor who recommended child be taken to ER for xrays. Child was diagnosed with a dislocated elbow which was popped back into place. The child left the hospital with no restrictions and returned to the facility the next day.
Director met with C2's mother to create a behavioral plan with child's family and staff in order to support C2 in developing skills to prevent similar interactions from happening in the future.

Director reported that there were seven children supervised by three staff at time of incident. Given the incident was observed by staff who took appropriate action in rendering first-aid and contacting the parents of the children involved, no deficiencies are being issued as a result of this incident.

LPA observed Notice of Site Visit Posted.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K StewartTELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2019
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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