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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364817412
Report Date: 02/08/2024
Date Signed: 02/08/2024 03:49:17 PM

Document Has Been Signed on 02/08/2024 03:49 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:FUNDAMENTALS PRESCHOOL ACADEMY, THEFACILITY NUMBER:
364817412
ADMINISTRATOR:EVELYN CHINCHILLAFACILITY TYPE:
850
ADDRESS:2424 KENDALL DRIVETELEPHONE:
(909) 887-1150
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92407
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 28DATE:
02/08/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:EVELYN CHINCHILLATIME COMPLETED:
02:02 PM
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On February 8, 2024 Licensing Program Analyst (LPA) Babatunde Ibitoye met with Director Evelyn Chinchilla to conduct an unannounced case management inspection.The purpose of the case management was to follow up on a self- reported unusual incident report (UIR) submitted to the Department on January 31, 2024

Description of incident: On 01/30/24 at around 10:30 am Child #1 was playing outside. C#1 was walking under a play structure and tripped over her own feet falling on the rubber surface. C#1 landed on her left arm. S#1 was 10 feet away and did not see the fall first hand. S#1 did not see C#1 as C#1 hit the ground because C#1 let out a scream. C#1 was picked up and comforted. When S#1 tried to check C#1 arm C#1 cried. C#1 wouldn't let anyone touch the arm. The center notified the parent,mom arrived,mom requested center to call paramedics. C#1 was taken to hospital via ambulance and it was determined that C#1 broke her arm.

During this investigation, LPA interviewed director S#1 and S#2.LPA was guided on a tour of the playground where the incident occurred. Based on interviews with S#1,S#2 and director the facility was in ratio on the playground at the time of the incident and observed the play structure area to be free of hazards to children's health or safety. No further action at this time.

Notice of Site Visit shall be posted for thirty (30) consecutive days. Failure to maintain posting as required will result in a $100 civil penalty.

An exit interview was conducted and a copy of this report has been signed by and provided to the director Evelyn Chinchilla, Site Visit and Appeal Rights were given.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2024
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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