Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406214335
Report Date: 03/05/2015 12:00:00 AM
Date Signed 07/23/2015 04:41:34 PM

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:NIPOMO RECREATION-LITTLE BITS PRESCHOOL & TODDLERFACILITY NUMBER:
406214335
ADMINISTRATOR:NANCY MAROHNFACILITY TYPE:
840
ADDRESS:112 ORCHARD ROADTELEPHONE:
(805) 929-5437
CITY:NIPOMOSTATE: CAZIP CODE:
93444
CAPACITY:60CENSUS: 25DATE:
03/05/2015
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:TIME COMPLETED:
04:15 PM
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This is an AMENDED REPORT to original report created on March 5, 2015.



A Case management visit was conducted by Licensing Program Analyst Martina Jimenez (LPA) who met with Director Kathy Bumgardner regarding a child bitten on the arm.

On February 20, 2015, Staff #1 was supervising the children eating breakfast. Child #1 was having a difficult morning. Child #1 earlier had attempted to scratch staff #1 in the face. Child#1 has also attempted to bite staff #1 and other children prior to the incident on that morning. Child #2 sustained a red mark on his lower back. Ice was applied to child #2 and the parents were contacted immediately. When guardian arrived to pick child #1 guardian grabbed child #1 left arm bitting child #1 on the upper left arm. Guardian stated to child#1 "that doesn't feel good does it?' Child #1 was screaming in pain. Guardian took child #1 from the class and left the facility. Director stated there were 1 teacher and 2 Assistants present with 8 children present when the incident occurred. Center reported incident Child Welfare Services and Community Care Licensing as required. Review of teacher child ratios revealed the center was in compliance with ratios on the day of the incident.



No deficiencies cited.

FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.
SUPERVISOR'S NAME: Deborah AjaoTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805)722-5132 FAX 685-1820
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2015
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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