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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215725
Report Date: 05/04/2023
Date Signed: 05/04/2023 11:50:09 AM

Document Has Been Signed on 05/04/2023 11:50 AM - 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:VILLALBA FCC AKA LOTS OF LOVE DAYCAREFACILITY NUMBER:
426215725
ADMINISTRATOR:XIMENA L. VILLALBAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 658-6222
CITY:SANTA BARBARASTATE: CAZIP CODE:
93103
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
05/04/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:46 AM
MET WITH:Ximena VillalbaTIME COMPLETED:
12:20 PM
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On May 4, 2023 Licensing Program Analyst (LPA) Susana Martinez conducted an unannounced Case Management- Incident inspection. LPA met with licensee Ximena Villalba and advised her of the purpose for the inspection. Together with the licensee, LPA toured the home inside and outside. At the time of inspection there were 10 children along with licensee and two assistants.

On 4/26/23 the Department received an Unusual Incident Report from the licensee involving a child (C1) who tripped and fell into a book shelf causing an injury to the head which required medical attention. The licensee reported that at around 8:05 am on 4/26/23, C1 was running in living room and tripped on something. Licensee states she has rugs in the living-room, but she was sure that was not the cause of the trip. C1 was running and ran into a bookcase and caused an open wound on forehead. The licensee states she administered first aid to the child and contacted the parents right away. C1's parents took child to the doctor. C1's injury required 6 stitches.

At the time of inspection, LPA observed C1 to be in care. Licensee states C1 returned to the day care home the next day after the incident. LPA was able to observe safety padding placed on the book shelf. Licensee states she added the padding to the book shelf as soon as possible to prevent another incident. LPA did not observe any tripping hazards during today's inspection.

Given the facility's account of the incident when reporting it to CCL and how they addressed the incident, LPA deemed the facility's action was appropriate.

No deficiencies were issued 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 in Spanish with the licensee Ximena Villalba.
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2023
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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