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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566214398
Report Date: 10/03/2024
Date Signed: 10/03/2024 01:40:19 PM

Document Has Been Signed on 10/03/2024 01:40 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:LITTLE TREE PRESCHOOL, THEFACILITY NUMBER:
566214398
ADMINISTRATOR/
DIRECTOR:		LYDIA FEDORAKFACILITY TYPE:
850
ADDRESS:1690 E. MAIN STREETTELEPHONE:
(805) 652-1609
CITY:VENTURASTATE: CAZIP CODE:
93001
CAPACITY: 55TOTAL ENROLLED CHILDREN: 55CENSUS: 40DATE:
10/03/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:13 PM
MET WITH:Lydia FedorakTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On 10/03/2024 Licensing Program Analyst (LPA) German Negrete made an unannounced visit for the purpose of completing a Case Management - Incident inspection. Today LPA met with Center Director Lydia Fedorak, LPA did a walk through of the Child Care Center(CCC) with the Director. LPA observed at the time of the walk-through 40 children being supervised by 5 staff.

The purpose of the case management inspection was due to a incident that occurred on 09/05/2024. The center reported the incident to the Department as required. C#1 was playing outside with a water activity in the morning, during recess time. S#1 was providing care supervision. S#1 began organizing the play area in order to take the children inside the facility. Then S#1 observed C#2 approach C#1 and push C#1. As C#1 fell to the ground C#1's forehead impacted a table/bench(see photos). According to S#1, S#1 picked up C#1 and applied paper napkins on C#1's forehead. Also S#1 informed S#2 to stay with the children outside, as S#1 took C#1 inside with the director. Then the director contacted parents. Parent took C#1 to the Emergency Room( Community Memorial)and C#1 received 2 stitches.

During the inspection, LPA reviewed the incident report and discussed the incident with the Director, and conducted staff interviews.

Based on the record review and observations, it was discovered staff followed reporting requirement as outlines by Child Care Regulations, Title 22 and acted accordingly in supporting C#1 during the incident.

Investigation concluded and exit interview conducted with director. Notice of site visit was issued.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: German Negrete
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2024
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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