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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215117
Report Date: 09/13/2022
Date Signed: 09/13/2022 01:27:59 PM


Document Has Been Signed on 09/13/2022 01:27 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:CAPSLO-GEORGIA BROWN EARLY HEAD STARTFACILITY NUMBER:
406215117
ADMINISTRATOR:JUDE CONTRERASFACILITY TYPE:
850
ADDRESS:3600 OAK ST. ROOM 105TELEPHONE:
(805) 226-9945
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY:16CENSUS: 9DATE:
09/13/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:33 PM
MET WITH:Jude ContrerasTIME COMPLETED:
01:41 PM
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On September 13, 2022 at 12:38 PM, Licensing Program Analyst (LPA) Frank Pedroza conducted an unannounced Case Management inspection. LPA met with facility Director Jude Contreras and advised her the purpose of the inspection. LPA was provided a tour of the facility. There were nine (9) children in care at the time of the inspection.

On September 9, 2022, the facility contacted Community Care Licensing (CCL) to self report an incident of a child sustaining an injury while in care. The incident occurred around 10:50 AM where the children were outside playing in the recreation yard. C1 was riding a bike when C2 ran up to them. C2 started to put their hands in C1's face and then grabbed C1's face. At that moment C1 reacted by biting C2's right index finger. C2 immediate pulled their finger away when C1 started to bite causing a small bleeding scrape to C2's finger. Staff S1 observed and escorted C2 to staff S2. S2 escorted C2 into the classroom to wash their finger. A band-aid was applied to the cut on C2's finger with an ice pack. Staff contacted both children's parents/authorized representatives and informed them of the incident. Facility staff talked with children about the incident and how to better address the incident. Staff provided guidance on how to not bite but use their words.

According to the facility staff the child did return back to care on September 13, 2022. The child did not require medical attention for the bite/scrape. Given the facility's staff account of the incident when reporting it to CCL and how they addressed the incident, LPA deemed facility's action was appropriate.

No deficiencies were cited during today's visit.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2022
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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