364846174-1-30-2024-09-CC-PBEY-CZYT2Q-20240130132107

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364846174
Report Date: 01/30/2024
Date Signed: 01/30/2024 01:21:10 PM

Document Has Been Signed on 01/30/2024 01:21 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	FAIRYTALE CASTLE PRESCHOOL		FACILITY NUMBER:	364846174
ADMINISTRATOR:	DIANNE TALENS		FACILITY TYPE:	850
ADDRESS:	710 EAST FOOTHILL BLVD		TELEPHONE:	(626) 567-5678
CITY:	UPLAND	STATE: CA	ZIP CODE:	91786
CAPACITY: 116	TOTAL ENROLLED CHILDREN: 116	CENSUS: 42	DATE:	01/30/2024
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	12:29 PM
MET WITH:	Dianne Talens/director		TIME COMPLETED:	01:50 PM

NARRATIVE

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On 1/30/2024 at 12:29 pm, Licensing Program Analyst (LPA) Patricia Berry conducted a subsequent case management- incident investigation. LPA met with Dianne Talens and was granted access into the facility. LPA toured the facility and took a census.

The visit was conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 12/7/2023.

Facility records were reviewed, and staff were interviewed on 1/22/24.

It was reported a child got their fingers caught in a door frame. It was reported staff was opening the door for a parent when the incident happened. Staff stated they did not see the child at the door when the door was closing.

Based on information gathered, the incident was an accident. The facility staff acted appropriately, (staff called 911 immediately, facility staff called the parents, facility staff reported the incident to Community Care Licensing). No violations have been identified.

See LIC 9102 Technical Assistance Advisory Note.

An exit interview was conducted, and a copy of this report was provided to director and appeal rights and LIC 9102 Technical Advisory Note provided.

Notice of Site Visit issued and must be posted for 30 days.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

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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