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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566213717
Report Date: 02/26/2024
Date Signed: 02/26/2024 12:17:20 PM


Document Has Been Signed on 02/26/2024 12:17 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:CDR - SIERRA LINDA HEAD STARTFACILITY NUMBER:
566213717
ADMINISTRATOR:SUZANNE GODINEZFACILITY TYPE:
850
ADDRESS:2201 JASMINE STREETTELEPHONE:
(805) 485-9800
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY:48CENSUS: DATE:
02/26/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:58 AM
MET WITH:Dina Elzahed TIME COMPLETED:
12:20 PM
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On February 26, 2024 Licensing Program Analyst (LPA) Giovani Gonzalez conducted an unannounced Case Management - Incident inspection at the above-mentioned Child Care Center (CCC). LPA met with Site Supervisor Dina Elzahed and informed them the purpose of the inspection. LPA in the company of the Site Supervisor toured the facility. At the time of the inspection there was 34 children present.

On 1/29/2024, Assistant Manager Bill Woods contacted Community Care Licensing (CCL) to self-report an incident of a child (C1) was on the back seat of a 2 seat tricycle. C1 fell off the tricycle and landed on their left arm on the concrete. CCC contacted parent and informed them of the incident and advised parent to take C1 to the doctor. Parent of C1 informed CCC on 1/26/2024 that C1 had a fractured elbow.

LPA interviewed the staff member (S1) that witnessed the incident occur. S1 stated that the tricycle went onto the grass next to the bike path which caused the children to fall of the tricycle. S1 stated that the child steering the tricycle fell on the grass and C1 fell on the bike path. S1 stated that there were no other children on the bike track. LPA observed where the incident occurred and did not see any hazards that could have caused the incident to occur.

The incident was determined to be risk at play. The CCC took the appropriate steps in comforting C1, notifying parents immediately, and reporting the incident to CCL, no deficiencies are being cited as a result of this incident.

Exit interview with Site Supervisor Dina Elzahed was conducted and notice of site visit was given.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Giovani GonzalezTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2024
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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