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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600816
Report Date: 05/22/2024
Date Signed: 05/22/2024 02:45:19 PM

Document Has Been Signed on 05/22/2024 02:45 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 SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:ESCONDIDO COMMUNITY CHILD DEVELOPMENT CENTERFACILITY NUMBER:
376600816
ADMINISTRATOR/
DIRECTOR:		MONIQUE GAPUZFACILITY TYPE:
850
ADDRESS:613 E LINCOLN AVENUETELEPHONE:
(760) 839-9330
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY: 109TOTAL ENROLLED CHILDREN: 109CENSUS: 76DATE:
05/22/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:37 PM
MET WITH:Erika ParadaTIME VISIT/
INSPECTION COMPLETED:
03:05 PM
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On 05/22/2024 at 1:37 pm, Licensing Program Analyst (LPA ) Gabriela Hernandez conducted an unannounced case management visit in regards to an unusual incident report received on 05/01/24. Per incident report, Child 1 (C1) sustained a right Corneal Abrasion on 04/30/24.
LPA interviewed S1 in regards to the incident. S1 stated she was called over by other staff members to look at C1’s eye at around 10:00 am. C1 was wearing a beanie the day of the incident. Per C1, she saw a small piece of lint in the eye of C1. C1 was rubbing their eye and stated it was hurting. S1 took C1 to the bathroom, applied water and cleaned their eye off with paper towel. S1 asked C1 if they were feeling better. C1 stated yes. C1 returned to play and was picked up by father at approx. 3:30 pm. Per S1, the father was notified of the incident at pick up time. S1 provided LPA with a copy of the ouch report confirming parents were notified.
On 05/01/24, the father of C1 contacted the center and stated he was going to take C1 to the emergency room. C1 was stating his eye was still hurting. C1 also woke up with a swollen eye per father. The doctor informed parents C1 had sustained a right corneal abrasion. C1 was prescribed eye drops in the affected eye 4 times a day for approx. 7 days. The center was directed to only administer 2 eyes drops per day; the other 2 were done at home. C1 returned to center on 05/03/24. I reviewed the incidental medical services authorization form; parents gave consent for staff on site to give eyedrops to C1.

At approx. 2:00 pm, LPA went to the classroom to check on C1; however C1 was taking a nap. Per S1, C1 is doing well and no longer has any pain. The last day the eyes drops were administered at the center were on 05/06/24.

Based on all the information obtained by LPA, there did not appear to be any violations of Title 22 Regulations pertaining to the reported incident.
An exit an interview was conducted. A copy of this report and appeal rights were provided at the time visit. A notice of site visit was given and shall remain posted for 30 days.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Gabriela Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2024
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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