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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 330910709
Report Date: 04/20/2023
Date Signed: 04/20/2023 12:51:34 PM

Document Has Been Signed on 04/20/2023 12:51 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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:CVUSD - PALM VIEW HS CENTERFACILITY NUMBER:
330910709
ADMINISTRATOR:MARCELLA ZAMUDIOFACILITY TYPE:
850
ADDRESS:1390 7TH STREETTELEPHONE:
(760) 848-1644
CITY:COACHELLASTATE: CAZIP CODE:
92236
CAPACITY: 44TOTAL ENROLLED CHILDREN: 18CENSUS: 16DATE:
04/20/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:54 AM
MET WITH:Jean-Mari DagarinTIME COMPLETED:
11:06 AM
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On April 20, 2023 Licensing Program Analyst (LPA) Ana Noble arrived at the facility on a case management inspection to follow-up on an Unusual Incident Report (UIR) which occurred on March 10, 2023. At the time of inspection, LPA toured the facility, took census, met with Ms. Andrea Taboda which is a substitute teacher to discuss the purpose of the visit. LPA later met with Jean-Mari Dagarin, Early Education Coordinator.

The reported incident took place on March 10, 2023, Child #1 was unresponsive and paramedics were call and transported to hospital.

The information that was obtained indicates during wake up time from napping, upon attempting to wake the child up, Child #1 (C1) would not wake up. Staff #1 (S1)and Staff #2 (S2) both attempted to wake up the C1. The elementary school health staff was called to evaluate C1, at which time emergency services were called due to C1 lack of responsiveness, C1 mother rode with C1 in the ambulance. C1 has not returned to school since this incident. Attempts to contact C1 parent have been unsuccessful. The information that has been provided to the facility and LPA by C1 parent was verbal information only, which indicates that the child had seizures.

Based on the information provided during interviews, there is no violation of Title 22 Regulation, pertaining to the reported incident.

An exit interview was held with Jean-Mari Dagarin, Ed Coordinator. A Notice of Site visit was issued, along with a copy of this report. This report shall be public record for three years.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE: DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/20/2023
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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