566215635-3-1-2022-17-CC-BCES-CC4S5M-20220301123435

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566215635
Report Date: 03/01/2022
Date Signed: 03/01/2022 12:34:42 PM

Document Has Been Signed on 03/01/2022 12:34 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	CDR - MARY CRAWFORD CENTER		FACILITY NUMBER:	566215635
ADMINISTRATOR:	PALMIRA LUNA		FACILITY TYPE:	850
ADDRESS:	2501 GISLER AVE.		TELEPHONE:	(805) 883-9154
CITY:	OXNARD	STATE: CA	ZIP CODE:	93033
CAPACITY:	40	CENSUS: 35	DATE:	03/01/2022
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Palmira Luna		TIME COMPLETED:	12:50 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On March 1, 2022 at 10:25 AM, Licensing Program Analyst (LPA) Betzayra Cervantes made an unannounced visit to conduct a Case Management - Incident inspection. LPA met with Site Supervisor Palmira Luna and discussed the nature and purpose of the visit and together a tour of the facility was conducted both inside and outside. The center is located on the premises of Harrington Elementary School. LPA observed a total of 35 children under the care and supervision of 7 teachers including the Site Supervisor. On 2/23/2022, the center self reported to Community Care Licensing (CCL) an incident that occurred on 2/23/2022 at or around 9:20AM where Child #1 sustained a fractured right arm. There were 11 children under the care and supervisor of 2 staff. The children were playing outside on the playground. Child # 2 was playing with a 2.5 foot long PVC pipe. LPA was advised the pvc pipe and connectors are considered "Loose Parts" and are listed as learning tools from "The Outdoor Classroom Project". Interview with staff reveal that C2 was hitting the metal support pole underneath the slide with the object. C2 was told to stop and he stopped for awhile. C1 walked by him and he had began swinging again and hit C1 on the right forearm. C1 fell onto his right arm and began to cry. S1 immediately went over to him, but did not see the incident happen. S1 carried C1 over to the benches where she inspected the child for injuries. S1 stated that she only observed redness on the child's right arm. Staff interviews revealed that neither S1 or S2 saw the incident. S2 was with another group of children and did not observe the incident, but heard C1's cry and observed S1 provide first aid. Staff immediately contacted the child's parent and advised her of what happened. C1's mother arrived within an hour of the incident and took him to Urgent Care. C1 was diagnosed with a fractured right upper arm. C1's arm was placed in a sling. C1 returned to the facility on 3/1/22. During record review, LPA observed C1's health plan. Site Supervisor informed LPA that center has been in communication with C1's mother regarding restrictions and modified activities. CONT ON LIC 809-C

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Betzayra Cervantes	TELEPHONE: (805) 680-7175
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: CDR - MARY CRAWFORD CENTER	FACILITY NUMBER: 566215635
	VISIT DATE: 03/01/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Health plan states the C1 is restricted from all physical activity and sand play until approved by orthopedic surgeon. Site Supervisor advised that the facility is providing alternate activities for C1 and providing extra support for the child as needed, including using the restroom.

LPA spoke with Site Supervisor about what steps the facility can to take to minimize an incident like this again. LPA was advised the center will provide close supervision when the children are playing with open ended materials. Site Supervisor provided staff training on 2/24/22 going over the topics of: active supervision, modeling toys to children, and outdoor zoning. LPA reviewed staff training agenda during file review. Center removed the toys out of an abundance of precaution. Staff will continue to provide active supervision and zoning in the play yard. Site Supervisor reviewed safety practices and expectations with staff and reminded children on how to play safely and use the equipment.

Based on the information obtained from staff interviews as well as the LPA's observations, LPA determined there were no deficiencies and that CCC functioned in accordance with Title 22 regulations.

A Technical Advisory has been issued for the following C.C.R., Div. 12, Title 22 Regulation: 101239(m)(1) Fixtures, Furniture, Equipment and Supplies.

No deficiencies were cited during today's visit. Exit interview conducted and report was reviewed with the Site Supervisor, Palmira Luna.

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Betzayra Cervantes	TELEPHONE: (805) 680-7175
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2022

LIC809 (FAS) - (06/04)

Page: 2 of 2