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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421712022
Report Date: 08/22/2024
Date Signed: 08/22/2024 02:34:12 PM

Document Has Been Signed on 08/22/2024 02:34 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:CAC - CUYAMA CENTERFACILITY NUMBER:
421712022
ADMINISTRATOR/
DIRECTOR:		KIM EICHERTFACILITY TYPE:
850
ADDRESS:2300 HIGHWAY 166TELEPHONE:
(661) 522-8813
CITY:CUYAMASTATE: CAZIP CODE:
93254
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 14DATE:
08/22/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:01 PM
MET WITH:Bertha Zendejas De GodoyTIME VISIT/
INSPECTION COMPLETED:
02:45 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
On 8/22/24, at 1:01 PM, Licensing Program Analysts (LPAs) Elvin Baddley and Matthew Sapien conducted an unannounced Case Management Inspection of the CAC (CommUnify)- Cuyama Child Care Center (CCC) to follow up on a Unusual Incident Report (UIR) received by the Department on 4/16/24. LPAs met with Bertha Zendejas De Godoy, Site Supervisor of the CCC and explained the purpose of the inspection. LPAs toured the interior and exterior of the CCC.

The UIR involved children in care (C1 and C2) swing back and forth on a high bar. C1 fell off of the high bar and hit the back of his head on a nearby bench, while C2 fell off of the high bar and landed on the ground (grassy area). C1 sustained a cut on the back of his head, while C2 sustained no injuries. It should be noted CCLD staff attempted to inspect the CCC to follow up on the UIR on 5/17/24, however the CCC was closed for a summer recess.

LPAs discussed the UIR with Site Supervisor and viewed the location where the incident occurred. Site Supervisor informed LPAs the high bar was removed from the CCC's outdoor play area shortly after the incident as the high bar had excess rust spots. Site Supervisor noted the high bar was age appropriate. Site Supervisor informed LPAs C1 and C2 have transitioned to elementary school. Further, C1 and C2 showed no prolonged effects related to the incident.

No deficiencies are cited during today's 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 Berta Zendejas De Godoy.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2024
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