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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701163
Report Date: 12/08/2021
Date Signed: 12/08/2021 04:19:13 PM

Document Has Been Signed on 12/08/2021 04:19 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
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:TOGETHER WE GROWFACILITY NUMBER:
376701163
ADMINISTRATOR:KIMBERLY CIERZANFACILITY TYPE:
850
ADDRESS:2120 THIBODO ROADTELEPHONE:
(760) 757-6031
CITY:VISTASTATE: CAZIP CODE:
92081
CAPACITY: 38TOTAL ENROLLED CHILDREN: 38CENSUS: 11DATE:
12/08/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Yvonne Bicchieri-Case-Regional Administrator and Kimberly Cierzan-Center DirectorTIME COMPLETED:
04:25 PM
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 Analysts (LPAs) Andrea Taylor and Linda Almaraz conducted a Case Management Inspection due to the Regional Office receiving a self reported incident received on 11/15/21 and a second self reported incident received on 11/19/21.

One incident occurred on 11/12/21 when a staff member gave a child with allergies food to which the child was allergic. About 5 minutes later the staff member noticed rapid breathing and out breath when talking.
The staff member realized child was having an allergic reaction and took the child to the Director's office for medial care. An Epi-Pen was used and child was transported to the hospital via ambulance.

The second incident occurred on 11/17/21 when a different staff member gave a child with allergies food to which the child was allergic. The staff member remembered child's allergy and took the food away, but the child was already having a reaction requiring an Epi-Pen to be used on the child. The child went to the hospital and was examined and released.

LPAs verified with Yvonne Bicchieri, Regional Administrator and Kimberly Cierzan, Director, the whole staff have been re-trained to recognize symptoms of allergic reactions and how to use an Epi-Pen.
They verified the staff have implemented a 2 step verification for child's food tray when serving the food to the children.The person preparing the trays of food will check each tray which has child's name for any food the child is allergic against the list of allergies posted in kitchen. Staff understand the children's information is confidential and will ensure it is kept in a place not visible to the parents or anyone who is not staff.
There are general flyers around the classrooms reminding staff to check for allergies.

An exit interview was conducted. A notice of site visit was issued and LPAs verified the Notice of Site Visit was posted in a prominent location prior to leaving. The Licensee understands that it must remain posted for 30 days.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Andrea Taylor
LICENSING EVALUATOR SIGNATURE: DATE: 12/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/08/2021
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