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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700504
Report Date: 11/04/2022
Date Signed: 11/04/2022 11:26:03 AM

Document Has Been Signed on 11/04/2022 11:26 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:VILLAGE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
376700504
ADMINISTRATOR:IRMA E AYALAFACILITY TYPE:
850
ADDRESS:3220 MISSION AVENUETELEPHONE:
(760) 967-4776
CITY:OCEANSIDESTATE: CAZIP CODE:
92058
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: DATE:
11/04/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Irma AyalaTIME COMPLETED:
10:15 AM
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On November 4, 2022, Licensing Program Analyst (LPA) Jessica Rubio arrived unannounced to the facility to conduct a case management visit due to an unusual incident report submitted for an incident that occurred on 10/21/2022 involving an injury to a child (C1). C1 sustained a fractured elbow after going down the slide and falling. LPA met with Director (AD) Irma Ayala and conducted a tour of the facility. LPA observed the area where the incident occurred and conducted interviews with AD and one staff (S1), who was present when the incident occurred. LPA determined that the facility was not in violation of licensing regulations and acted appropriately. There were no deficiencies issued during this visit. An exit interview was conducted, a copy of this report, LIC 811 (Confidential Names List) and appeal rights were reviewed with and provided to Director Irma Ayala. A Notice of Site Visit was also provided and shall remain posted for 30 days.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Jessica M Rubio
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2022
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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