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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700970
Report Date: 11/07/2024
Date Signed: 11/07/2024 01:48:09 PM

Document Has Been Signed on 11/07/2024 01:48 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:QCS CHILDREN'S ACADEMYFACILITY NUMBER:
376700970
ADMINISTRATOR/
DIRECTOR:
SANCHEZ, JENNIFERFACILITY TYPE:
850
ADDRESS:341 HEALD LANETELEPHONE:
(760) 451-9885
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY: 30TOTAL ENROLLED CHILDREN: 26CENSUS: 25DATE:
11/07/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:58 AM
MET WITH:Jennifer SanchezTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On 11/07/24, Licensing Program Analyst (LPA), Kelli Waters, conducted an unannounced Case Management visit to follow up on Unusual Incident Report (UIR) that was submitted to Licensing by the facility on 11/04/24, regarding an incident that took place on 10/30/24. LPA met with Site Supervisor, Jennifer Sanchez to discuss incident.

The Site Supervisor reported the following; on October 30, 2024, Staff #1 (S1) reported to the Site Supervisor that Child #1 (C1) had fell and hit the back of head on the right side while outside on the playground. C1 had an open cut and was bleeding.

After investigating, LPA Waters determined that the facility took the necessary steps to ensure the safety of the children. Based on the information obtained during the visit, there appears to be no violations of Title 22 Regulations pertaining to the reported incident.

LPA Waters reminded Site Supervisor that according to regulation 101212(d) unusual incidents must be reported by telephone or fax by the next working day and that a written report must be submitted within 7 working days.

An exit interview was conducted, and a copy of this report was provided.

A copy of this report must be made available to the public, at the facility site, for 3 years.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Kelli Waters
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2024
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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