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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 440706333
Report Date: 11/02/2023
Date Signed: 11/02/2023 01:48:54 PM


Document Has Been Signed on 11/02/2023 01:48 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:SANTA CRUZ TODDLER CARE CENTERFACILITY NUMBER:
440706333
ADMINISTRATOR:NORA CARUSOFACILITY TYPE:
830
ADDRESS:1738 16TH AVENUETELEPHONE:
(831) 476-4120
CITY:SANTA CRUZSTATE: CAZIP CODE:
95062
CAPACITY:20CENSUS: 5DATE:
11/02/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Nora CarusoTIME COMPLETED:
01:58 PM
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Licensing Program Analyst (LPA), Cortney Nelson, met with Site Director, Nora Caruso, and explained purpose of visit, to follow-up on incident that was self-reported to the Department on 5/17/2023. Upon arrival, LPA was admitted into the facility by Nora.

The facility self-reported an incident that occurred on 5/11/2023 regarding an infant who sustained injuries, including a split lip and small scrapes/abrasions on the chin and cheek. On 5/17/2023, it was determined the child also sustained a fractured tibia.

Department of Social Services Investigator, Eddie Phung, conducted a follow-up investigation regarding the injuries sustained by the infant and possible lack of supervision at the facility. The investigation included interviews with staff, Site Director, parents, and medical professionals, review of pertinent documents such as child’s file and medical reports, and observation of the outside play area where the injury occurred. After completing the investigation, Investigator Phung concluded that although staff did not witness the injury occur, the injury was not a result of lack of supervision by staff present at the facility. A child abuse expert from Kaiser Permanente was consulted and advised that the injury sustained by the infant is considered common in mobile infants of that age and it is common for injuries of this type to lack witnesses. Based on the available evidence, there are no concerns regarding abuse or neglect of infants by the facility.

As a result of today’s inspection, no deficiencies were cited.

Exit interview conducted and report was reviewed with the Site Director, Nora Caruso.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST BE POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney NelsonTELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2023
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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