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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566208207
Report Date: 12/09/2019
Date Signed: 12/09/2019 12:21:00 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:GUEVARA FCC AKA BABY LOONEY TUNES FCCFACILITY NUMBER:
566208207
ADMINISTRATOR:MARIA GUEVARA/LEGALFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 815-8597
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY:14CENSUS: 3DATE:
12/09/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Maria GuevaraTIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Michael Avila made an unannounced visit for the purpose of conducting a Case Management inspection. On Friday December 6, 2019, Licensee self reported a parent (P1) called concerned about a bump on her child (C#1) right eye.

LPA met with Licensee Maria Guevara and discussed the nature and purpose of the visit. Although Licensee does not know how the injury actually occurred, Licensee believed the injury may have occurred when the child slipped while standing on a stool in the restroom. LPA reviewed text messages between the parent and Licensee where the parent states the child told her he hit his right eye on the door in the restroom. LPA observed a plastic stool children usually use as a step in the restroom which may have slipped causing the child to fall forward. Licensee replaced the stool with another stool with a rubber base and placed a mat on floor to prevent any further slip and falls in the restroom.

No deficiencies were issued during this visit.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Michael AvilaTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2019
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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