Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426213750
Report Date: 05/22/2019
Date Signed 05/22/2019 11:09:29 AM

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:LA PURISIMA CONCEPCION LITTLE SAINTS PRESCHOOLFACILITY NUMBER:
426213750
ADMINISTRATOR:TERESE MUNOZ-HILLFACILITY TYPE:
850
ADDRESS:219 W. OLIVE AVENUETELEPHONE:
(805) 736-6210
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:87CENSUS: 72DATE:
05/22/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Terese Munoz-HillTIME COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Sylvia Mendoza-Ceja conducted an unannounced visit to the center. LPA met with Director Terese Munoz-Hill regarding an incident she reported to the Department as required. LPA toured the area where the incident occurred and interviewed Director. LPA also reviewed child #1's file.

On April 30, 2019, an incident occurred on the playground when child #1 was walking on the wooden stumps (approximately 1 1/2 feet high) and slipped and fell. Staff #1 was supervising the area and immediately assisted child #1 up and notified the Director. Director stated she consoled child #1 and first aid was administered. Parent was contacted regarding the incident. Child #1 sustained an injury that required medical attention. Director stated there were four teachers supervising 48 children on the playground when the incident occurred.

Director stated, the following day after the incident the wood stumps where child #1 fell had been removed from the playground. Director also stated she is working with the Outdoor Classroom Project to renovate the yard this summer.

No deficiencies were cited.

FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
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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