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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372005131
Report Date: 04/24/2024
Date Signed: 04/24/2024 02:28:18 PM

Document Has Been Signed on 04/24/2024 02:28 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:BALDERRAMA CHILD DEVELOPMENT CENTERFACILITY NUMBER:
372005131
ADMINISTRATOR/
DIRECTOR:		YATES, ANDREAFACILITY TYPE:
850
ADDRESS:709 SAN DIEGO ST.TELEPHONE:
(760) 757-1931
CITY:OCEANSIDESTATE: CAZIP CODE:
92058
CAPACITY: 80TOTAL ENROLLED CHILDREN: 80CENSUS: 34DATE:
04/24/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:01 PM
MET WITH:Andrea WoodTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Kelly Gerth and Sumayya Habeebulla arrived at the facility for the purpose of conducting a case management visit. The Department received an unusual incident report (UIR) dated 04/16/24 from the facility stating a child was left unattended without supervision for a period of time during operational hours.

LPAs conducted interviews with pertaining parties, and it was found that Child 1 was playing in the courtyard on a furniture moving dolly. S1 redirected C1 from the equipment and placed the equipment inside an area of the building which is off limits for children. S1 proceeded and left for prep time and S2 stepped in to supervise the children. During the transition time, C1 entered the off-limits area without the staff being aware of it. S3 who was inside the kitchen area noticed C1 wandering in the hallway playing with 2 robots. S3 guided the child out of the building into the courtyard and notified the staff supervising the children in the classroom. Staff was not aware of the missing child and did not notice the child wander away.

From the information received by interviews with staff, and eyewitness, the facility is being cited for violation of the California Code of Regulations Title 22 Section 101229(a)(1) Responsibility for Providing Care and Supervision



See LIC 809D for deficiencies cited.

An exit interview was conducted with the Director Ms. Andrea Wood, a Notice of Site Visit posted, and a copy of this report was provided to the facility on this date and time.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Kelly Gerth
LICENSING EVALUATOR SIGNATURE: DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2024
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 2
Document Has Been Signed on 04/24/2024 02:28 PM - It Cannot Be Edited


Created By: Kelly Gerth On 04/24/2024 at 01:47 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: BALDERRAMA CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 372005131

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/25/2024
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary...(1) No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual ...
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The Facility Director agrees to review Title 22 section with staff and retrain staff on the Responsibility for Providing Care and Supervision. The Director will provide a written statement of understanding/compliance to the Department by the due date.
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This requirement was not met as evidenced by: Based on interviews during play yard time, a child wandered into an off-limit area of the building which is not part of the licensed facility without the knowledge of the staff.
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Director will provide LIC 9224 to all parents enrolled for a period of one year and keep a copy in the child's file for review by the Department.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Carlos Martinez
LICENSING EVALUATOR NAME:Kelly Gerth
LICENSING EVALUATOR SIGNATURE:
DATE: 04/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/24/2024


LIC809 (FAS) - (06/04)
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