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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406206830
Report Date: 07/24/2024
Date Signed: 07/24/2024 02:49:55 PM

Document Has Been Signed on 07/24/2024 02:49 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:SAN LUIS OBISPO CHILD DEVELOPMENT CENTERFACILITY NUMBER:
406206830
ADMINISTRATOR/
DIRECTOR:
MICHELLE HOLMFACILITY TYPE:
850
ADDRESS:1720 BISHOP ST.TELEPHONE:
(805) 544-0801
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93401
CAPACITY: 83TOTAL ENROLLED CHILDREN: 83CENSUS: 35DATE:
07/24/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Michelle HolmTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 7/24/24, Licensing Program Analyst (LPA) Elvin Baddley contacted an unannounced Case Management inspection of the abovementioned Child Care Center (CCC) to follow up on the report of an Unusual Incident Report (UIR) received by the Department on 7/1/24. Specifically, a child in care, herein C1, sustained a hairline fracture of the clavicle. The fracture occurred after C1 fell on to artificial grass turf while spinning in a circle with another child in care. LPA met with CCC Director Michelle Holms and Program Manager Kali Coleck and explained the nature of the inspection. LPA notes 35 children are on site along with 12 teachers providing care and supervision.

LPA, Director and Program Manager viewed area where C1 fractured the clavicle LPA notes the outdoor area is within the CCC's outdoor playground. The area is shaded and footing in leveled. As noted the ground is covered by an artificial turf which has some cushioning. Program Manager informed LPA the incident occurred after C1 lost balance and fell onto the ground. C2 proceeded to fall on top of C1. Program Manager and Director informed LPA the activity C1 and C2 were participating in was a normal activities and there was no inherent hazard. The fact C2 landed on top of C1 may have been the fact which aggravated C1's fall and been the basis for the injury.

To date, C1 is currently attending the CCC and has not prolonged issues related to the injury.

Based on observations and the interview with the Program Manager and Director, it is determined neither the equipment at the CCC nor the actions of the CCC's staff contributed to C1's incident. LPA best categorized the incident as an unfortunate accident.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2024
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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