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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313622381
Report Date: 11/19/2021
Date Signed: 11/19/2021 10:14:49 AM

Document Has Been Signed on 11/19/2021 10:14 AM - 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:KIDS' PLACE INCORPORATED, THE (PS)FACILITY NUMBER:
313622381
ADMINISTRATOR:GAROFALO, JESSICAFACILITY TYPE:
850
ADDRESS:956 MEADOW GATE ROADTELEPHONE:
(530) 878-7875
CITY:MEADOW VISTASTATE: CAZIP CODE:
95722
CAPACITY: 21TOTAL ENROLLED CHILDREN: 21CENSUS: 18DATE:
11/19/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jessica Garofalo - Director/LicenseeTIME COMPLETED:
10:30 AM
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On Friday, November 19th, 2021, at 9:04am, Licensing Program Analyst (LPA) Blake Morillas conducted a unannounced Case Management visit in regards to a received Unusual Incident Report (UIR). LPA informed the Licensee, Jessica Garofalo, of the reason for the inspection. Upon arrival there were 18 preschool children present along with 3 staff.

On 11-18-2021, the Licensee self reported an incident where a child was playing on a raised play structure and fell. It was later discovered that the child had sustained a fractured to their lower arm.

LPA toured the day care facility where the incident occurred, made observations, and interviewed staff regarding said self reported incident. It was determined that no Title 22 violations took place.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee, Jessica Garofalo.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Blake Morillas
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2021
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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