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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215293
Report Date: 12/15/2021
Date Signed: 12/15/2021 01:05:16 PM

Document Has Been Signed on 12/15/2021 01:05 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:CDR - OAK VIEW CENTERFACILITY NUMBER:
566215293
ADMINISTRATOR:SUZANNE GODINEZFACILITY TYPE:
850
ADDRESS:555 MAHONEY ST.TELEPHONE:
(805) 485-7878
CITY:OAK VIEWSTATE: CAZIP CODE:
93022
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 2DATE:
12/15/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Megan RamseyTIME COMPLETED:
01:20 PM
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On December 15, 2021 at 12:00PM, Licensing Program Analyst (LPA) Betzayra Cervantes made an unannounced visit to conduct Case Management - Incident inspection. LPA met with Site Supervisor Megan Ramsey and discussed the nature and purpose of the visit and together a tour of the facility was conducted both inside and outside. LPA observed a total of 2 children under the care and supervision of 4 teachers including the Site Supervisor.

On 12/02/2021, the center self reported to Community Care Licensing (CCL) an incident that occurred on 12/01/21 at or around 1:30PM where Child #1 sustained a broken left elbow. There were 11 children under the care and supervisor of 3 staff. The children were playing outside on the playground. Child #1 was playing with other children on the wooden logs, walking on top of them. The logs are about 2 ft tall. C1 ended up falling off of the log, onto the concrete, injuring his left elbow. C1 began to cry and walked over to the teacher (S1) who inspected the injury and only observed a small red mark on the child's arm. Staff interviews revealed that the 3 teachers outside were each helping another child and did not observe the incident. S1 stated that C1 was holding his left arm and told her that he slipped and fell on the log and pointed over to the log.

C1 was still crying once the class returned inside. S1 and S2 provided comfort and C1 was provided an ice pack for his arm. S2 observed C1 was unable to lift his left arm and it looked limp. Staff immediately contacted the child's parent and advised her of what happened. C1's mother arrived within 10 minutes of the incident and took him to the local Emergency Room (ER). C1 was diagnosed with a broken left elbow. C1's elbow required surgery and had pins placed to help stabilize and heal the broken bone. C1 has not returned back to the facility. Site Supervisor informed LPA that center has been in communication with C1's mother and is tentatively scheduled to return in January.

CONT ON LIC 809-C
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Betzayra Cervantes
LICENSING EVALUATOR SIGNATURE: DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2021
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CDR - OAK VIEW CENTER
FACILITY NUMBER: 566215293
VISIT DATE: 12/15/2021
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Site Supervisor advised that C1's mother was informed that the facility will require a doctor's note when C1 returns so the facility can address any needs and restrictions which includes no physical activity for 3 months.

LPA observed where the child had fallen off of the log. LPA spoke with Site Supervisor about what steps the facility can to take to minimize an incident like this again. Center removed the logs out of an abundance of precaution. Staff will continue to provide active supervision and zoning in the play yard. Site Supervisor reviewed safety practices and expectations with staff and reminded children on how to play safely and use the equipment.

Based on the information obtained from the Site Supervisor as well as the LPA's observations, LPA determined there were no deficiencies and that CCC functioned in accordance with Title 22 regulations.



No deficiencies were cited during today's visit. Exit interview conducted and report was reviewed with the Site Supervisor, Megan Ramsey.
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Betzayra Cervantes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
LIC809 (FAS) - (06/04)
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