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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153810036
Report Date: 02/03/2022
Date Signed: 02/03/2022 12:58:37 PM

Document Has Been Signed on 02/03/2022 12:58 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:WONDERFUL PRESCHOOL: LOST HILLSFACILITY NUMBER:
153810036
ADMINISTRATOR:HIXON, ALESHAFACILITY TYPE:
850
ADDRESS:14848 LAMBERSON AVETELEPHONE:
(661) 706-7689
CITY:LOST HILLSSTATE: CAZIP CODE:
93249
CAPACITY: 264TOTAL ENROLLED CHILDREN: 264CENSUS: 32DATE:
02/03/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Donna Ward TIME COMPLETED:
01:05 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 02/03/22 Licensing Program Analysts (LPAs) Araceli Gibson and Juvenal Moctezuma conducted an unannounced case management incident inspection. LPAs met with Site Supervisor, Donna Ward. LPAs followed up on an incident that was reported to CCL on 10/26/21. The incident involved an injury to a preschool child. On 10/26/21 a child was sliding down a curvy side and fell with injury to her right arm. Child required medical treatment of a splint to the right arm. Child returned to back to school on Monday 11/01/21. LPAs discussed the incident with the Site Supervisor regarding preventative safeguards to reduce the risk of future incidents. LPAs observed the slide to have new fresh bark for added cushioning to avoid future injuries. In addition, Site Supervisor stated they now schedule two staff to be outdoors when children are on the playground. Site Supervisor stated they are also in the planning stages of implementing a safety action plan for added safety.

The facility, notified authorized representatives, and properly documented the incident with Community Care Licensing.

Per California Code of Regulations Title 22, Division 12, Chapter 1 no deficiency cited during today's visit. Exit interview conducted with the Donna Ward.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Araceli Gibson
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2022
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