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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406205649
Report Date: 06/26/2024
Date Signed: 06/26/2024 01:41:08 PM


Document Has Been Signed on 06/26/2024 01:41 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:CHILDREN'S GARDEN, THEFACILITY NUMBER:
406205649
ADMINISTRATOR:MERCEDES PETWAYFACILITY TYPE:
840
ADDRESS:701 CROCKER ST.TELEPHONE:
(805) 434-1188
CITY:TEMPLETONSTATE: CAZIP CODE:
93465
CAPACITY:30CENSUS: 20DATE:
06/26/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Mercedes PetwayTIME COMPLETED:
01:40 PM
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On 6/26/24, at 11:45 AM, Licensing Program Analysts (LPAs) Joaquin Mendez and Elvin Baddley conducted an unannounced Case Management Inspection at the abovementioned Child Care Center (CCC) to address an Unusual Incident Report (UIR) received by the Department on 6/18/24. The incident involved a child (C1) in care fracturing a finger. The finger fracture was the result of a river rock falling from the top of a table onto C1’s hand in the CCC’s outdoor play area on 6/12.24.

LPAs met with Mercedes Petway, Director of the CCC and explained the nature and purpose of the inspection. LPAs, in the company of Director toured the interior and exterior of the CCC. LPAs observed 20 children in care along with three staff members at the time of the inspection. Director showed LPAs the location where the incident occurred as well as the size of the river rock (3 inch diameter) which fell onto C1’s finger. Director informed LPA children in care are not suppose place rocks on the table. Director explained staff members were in the process of having a child (C2) remove the rock from the table when it fells onto C1's finger. C1 was positioned near the base of the table when the incident occurred.

Director informed LPAs children in care regularly play with river rocks at the CCC. The rocks are used as building items to enhance the children’s manipulative skills.

Director noted no skin was broken on C1’s finger and immediately after the incident, there was no signs of broke breakage on C1’s finger. Director informed LPAs C1 was comforted after the incident and the parents of C1 were informed of the incident immediately thereafter. Parents placed a bandage on C1’s finger according to Director to mask C1 from seeing the injured finger. Parents and medical officials were unaware of the fracture in C1’s finger until six days after the incident, despite prior medical examinations. Additionally, Director informed LPA the CCC did not notify CCLD of the fracture to C1’s finger as staff members were unaware of the fracture. Director informed LPAs upon learning of the fracture CCLD was immediately notified via a phone call to the SBRO. It should be noted C1 was interviewed by LPAs.
(CONT. 809-C, Page)
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/26/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CHILDREN'S GARDEN, THE
FACILITY NUMBER: 406205649
VISIT DATE: 06/26/2024
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Given the LPAs’ observations, along with interviews and record reviews, it is determined the actions of CCC staff did not contribute to the C1's injury. Further, CCC staff acted in accordance with Title 22 regulations when reporting the incident . The incident is an unfortunate situation in which C1 inadvertently fractured a finger.

No deficiencies were cited during todays inspection.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Facility Representative Mercedes Petway
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
LIC809 (FAS) - (06/04)
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