334810225-10-5-2023-10-CC-AWIN-CWBMSU-20231005095232

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334810225
Report Date: 10/05/2023
Date Signed: 10/05/2023 09:52:38 AM

Document Has Been Signed on 10/05/2023 09:52 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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME:	NUVIEW UNION SCHOOL DISTRICT		FACILITY NUMBER:	334810225
ADMINISTRATOR:	JESENIA GARCIA MACIAS		FACILITY TYPE:	830
ADDRESS:	29680 LAKEVIEW AVENUE		TELEPHONE:	(951) 928-3570
CITY:	NUEVO	STATE: CA	ZIP CODE:	92567
CAPACITY:	56	CENSUS: 14	DATE:	10/05/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Jesenia Garcia Macias		TIME COMPLETED:	10:00 AM

NARRATIVE

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At 8:20AM on October 5, 2023, a case management visit is being conducted in response to an incident that occurred on September 5, 2023.LPA met with Director Jesenia Garcia Macias and Assistant Director Shandra Gonzalez.

On 09/05/23, Child #1 (C1) arrived to school at 10:04am and was very sleepy/tired. Staff held and tended to child for about 40 minutes as C1 woke up. Shortly after, C1 was playing and climbed up small furniture and fell off. C1 hit the top of head. C1 was assessed, comforted and ice was applied to the top of head. There were no marks, bruises or bumps observed and child continued to play. Parent was notified immediately and instructed to come pick up child. As staff waited for parents arrival, C1 was not allowed to go to sleep. Parent arrived and signed child out at 1:28pm.

The facility completed an internal accident report to document the incident. Since there was no obvious visual injury, bruising or bump, the Director did not submit an Unusual Incident Report to Licensing. According to the policy, the internal report was sufficient. If the child did receive further medical evaluation or treatment, the Director would have submitted an UIR. C1 returned to school the following day and there was no further incidents.

LPA received copies of all relevant paperwork. Based on information gathered, the facility acted appropriately and no violations have been identified.

An exit interview was conducted and a copy of this report was provided to Director Jesena Garcia Macias.

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 505-6334
LICENSING EVALUATOR NAME: Alaina Wilburn	TELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

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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