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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215293
Report Date: 12/18/2024
Date Signed: 12/18/2024 01:49:57 PM

Document Has Been Signed on 12/18/2024 01:49 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:CDR - OAK VIEW CENTERFACILITY NUMBER:
566215293
ADMINISTRATOR/
DIRECTOR:
SUZANNE GODINEZFACILITY TYPE:
850
ADDRESS:555 MAHONEY ST.TELEPHONE:
(805) 485-7878
CITY:OAK VIEWSTATE: CAZIP CODE:
93022
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 13DATE:
12/18/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Rebecca Caldwell TIME VISIT/
INSPECTION COMPLETED:
02:04 PM
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On December 18, 2024 Licensing Program Analyst (LPA) Giovani Gonzalez conducted an unannounced Case Management - Incident inspection at the above-mentioned Child Care Center (CCC). LPA met with Site Supervisor Rebecca Caldwell and informed them the purpose of the inspection was to follow up on an incident that occurred on 10/28/24. At the time od the inspection 13 children and 3 staff were present.

On 10/28/2024 at approximately 10:47AM the CCC had an incident where Child 1 (C1) jumped off a child sized couch and obtained an injury. After C1 had fallen and began to cry Staff 1 (S1) comforted C1, then noticed C1 was unable to move their arm and the arm began to swell. S1 then contacted parents which then arrived at approximately 11:00AM. Parent of C1 then took C1 to the emergency room where they were informed child had fractured their elbow.

During the inspection LPA observed the couches the child had jumped off an noted they were age appropriate and in good condition. Further, site supervisor had the couches removed from the children's area to prevent further incidents. Site supervisor informed LPA C1 was absent for a couple days but has been attending the CCC.

Based on the information gathered during the inspection, LPA determined that the staff took appropriate action to meet the needs of the child.

No deficiencies were issued as a result of the incident.

Exit interview conducted and report was reviewed with the Site Supervisor Rebecca Caldwell.

A notice of site visit was given.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2024
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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