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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600786
Report Date: 07/03/2023
Date Signed: 07/03/2023 12:39:15 PM

Document Has Been Signed on 07/03/2023 12:39 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:NCCS CHILD DEVELOPMENT CENTER-EUCALYPTUSFACILITY NUMBER:
376600786
ADMINISTRATOR:SANDRA ROMEROFACILITY TYPE:
850
ADDRESS:1805 S. ESCONDIDO BLVD.TELEPHONE:
(760) 745-1302
CITY:ESCONDIDOSTATE: CAZIP CODE:
92027
CAPACITY: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 0DATE:
07/03/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Shonna Brookin-WigginsTIME COMPLETED:
12:45 PM
NARRATIVE
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On July 3, 2023, at 12:00 PM Licensing Program Analyst (LPA), Courtnee Peebles met with NCCS CHILD DEVELOPMENT CENTER-EUCALYPTUS (CCC), Director, Shonna Brookin Wiggins to discuss an unusual incident that was reported to Community Care Licensing (CCL).

The Department was made aware of the incident of a child in the preschool classroom that swallowed an orbee. LPA informed Ms. Brookin-Wiggins that any unusual incident that occurs at the facility must provide age appropriate toys and all unusual incidents must be reported to the department within 24 hours through the Duty line and a written report must be submitted within 7 days.

The facility is being cited for Title 22 Regulation Section 101239 Fixtures, Furniture, Equipment and Supplies (m) All play equipment and materials used by children shall be age-appropriate.

(1) The licensee shall provide a variety of age-appropriate equipment, toys and materials in good condition and in sufficient quantity to allow children present to fully participate in planned activities.


An exit interview was conducted, and a copy of this report was provided to Director Shonna Brookin-Wiggins.

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

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Courtnee Peebles
LICENSING EVALUATOR SIGNATURE: DATE: 07/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/03/2023
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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Document Has Been Signed on 07/03/2023 12:39 PM - It Cannot Be Edited


Created By: Courtnee Peebles On 07/03/2023 at 12:21 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: NCCS CHILD DEVELOPMENT CENTER-EUCALYPTUS
FACILITY NUMBER: 376600786

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/03/2023
Section Cited
HSC
101239(m)(1)

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(m) All play equipment and materials used by children shall be age-appropriate.
(1) The licensee shall provide a variety of age-appropriate equipment, toys and materials in good condition and in sufficient quantity to allow children present to fully participate in planned activities.
This requirement has not been met as evidence by.....
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Director stated all orbeez have been thrown away and disposed of same day of incident on 06/13/2023.
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Based on interviews, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Pauline Beschorner
LICENSING EVALUATOR NAME:Courtnee Peebles
LICENSING EVALUATOR SIGNATURE:
DATE: 07/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/03/2023


LIC809 (FAS) - (06/04)
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