<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360906559
Report Date: 12/05/2024
Date Signed: 12/05/2024 10:58:27 AM

Document Has Been Signed on 12/05/2024 10:58 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:CSUSB CHILDREN'S CENTERFACILITY NUMBER:
360906559
ADMINISTRATOR/
DIRECTOR:		ALEXANDRIA CHUNGFACILITY TYPE:
850
ADDRESS:5500 UNIVERSITY PARKWAYTELEPHONE:
(909) 537-5928
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92407
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 22DATE:
12/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:06 AM
MET WITH:Lead Teacher/ Scarlett Flores MarinTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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
Licensing Program Analyst (LPA) Carol Heath met with the Lead Teacher, Scarlett Flores Marin, for a case management incident inspection involving a phone report of an Unusual Incident (UIR) received on 12/5/24. LPA toured the facility and took a census of the children. Upon arrival, there were 22 children with 6 teachers. LPA talked to Maribel Riggins, the administrative coordinator, about the purpose of the visit.
Description of the incident: An incident occurred on 11/25/2024. PRO Officer of the Day (OD) received a phone from the director to report UIR. A child was climbing on the playground structure outside the bridge bars. Teacher #1 told Child #1 to be careful and get down. When teacher #1 turned to attend to other children, the child moved, slipped, and fell on her back.

LPA toured the playground structure and talked to lead teacher #2 to find out more information. LPA talked to child #1 and asked child #1 to show LPA what happened on 11/25/2024. LPA obtained the facility roster and doctor's report for child #1.

Due to the director and the teacher #1 were absent today (12/5/2024). Further investigation is needed.
An exit interview was conducted, and a copy of the report was read and provided to the lead teacher, Scarlett Flores Marin.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2024
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 1