Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376624202
Report Date: 01/18/2018
Date Signed 01/18/2018 11:57:06 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:HIBBERT, BARBARA FAMILY CHILD CAREFACILITY NUMBER:
376624202
ADMINISTRATOR:BARBARA HIBBERTFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 761-9982
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY:14CENSUS: 5DATE:
01/18/2018
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Barbara HibbertTIME COMPLETED:
10:00 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Iman Al-Absi conducted an unannounced Case Management Inspection on this date. Upon arrival, LPA met with Licensee Barbara Hibbert. Also present in the home were five daycare children and Licensee's minor son/helper.

Purpose of today's inspection is to follow up on a self reported incident that occurred on January 4, 2018 where child # 1 pulled a cell phone charger from the wall resulting in the tip of charged to be in contact with child's eye. The incident occurred in the main play area of home. Child was taken to urgent care by parents.

Based on the interview conducted and a review of medical report, the incident has been determined to be accidental. Licensee acted appropriately and on time. Medical report indicates no injury of the eye. Since the incident, Licensee has refrained from charging cell phone in the play area. Supervision requirements were also discussed.

An exit interview was conducted.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Iman KayyaliTELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2018
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 1