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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215704
Report Date: 01/03/2023
Date Signed: 01/03/2023 03:58:55 PM

Document Has Been Signed on 01/03/2023 03:58 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:DUTY FAMILY CHILD CAREFACILITY NUMBER:
426215704
ADMINISTRATOR:AMANDA LYNN DUTYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 260-2066
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
01/03/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:41 PM
MET WITH:Amanda Duty TIME COMPLETED:
03:40 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 1/3/2023, at 2:41 PM Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced Case Management inspection to follow up on the self reported incident which occurred on 11/17/2022. LPA asked pre screening questions related to COVID- 19 and licensee’s responses indicate there are no COVID 19 exposures on site. LPA met with licensee, Amanda Duty and discussed the purpose of the inspection There were 3 children present at the time of the inspection.

Licensee, Amanda Duty reported that on 11/17/2022 on or about 10:30 AM, while Child # 1 (C1) was playing at the day care room, Child # 1 tripped and fell. C1 hits C1's forehead (between the eyes) on the pre school activity table. Licensee stated, she was in the same room attending to other children who were doing art activities. Licensee added she did not see the actual incident but heard the thumping sound in the table, she immediately turned around and saw C1 on C1's knees on the ground. C1 sustained an injury in between C1's eyes. Licensee observed the heavy bleeding and attempted to stop the bleeding by putting pressure on it. However, when the bleeding did not stop, 911 was called. Licensee was advised by the firefighter that child did not require to be transported by an ambulance. C1's parent came, picked up C1 and was brought to the urgent care and the injury/cut was glued. C1 was present at FCCH the following day, 11/18/2022.

During today's inspection, no deficiencies were cited.

Notice of Site visit was issued. Exit interview was conducted and report was reviewed with Licensee, Amanda Duty.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 01/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/03/2023
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