Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426213750
Report Date: 07/21/2017
Date Signed 07/21/2017 11:34:37 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) 735-7226
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:87CENSUS: 0DATE:
07/21/2017
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Cynthia MontelangoTIME COMPLETED:
11:45 AM
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A case management visit was conducted by LPA S.Mendoza-Ceja who met with Cynthia Montelango to follow up on two unusual incidents which were reported by the center to the Department as required.

On May 16, 2017, at approximately 11:30 AM, during transition time from the yard to go inside for lunch. Child #1 ran to line up to be first in line, tripped over another child and fell on a tree stump. Child #1 sustained a cut above his right eye. Staff administered first aid and contacted the parent immediately. Child #1 did receive medial attention. At the time of the incident, the Director and Assistant Director observed the incident; the ratio was six staff supervising 52 children on the playground. The Director spoke with the children about not running and to be aware of their surroundings.


On May 22, 2017, at approximately 12: 45 PM, child #2 and child #3 were observed by staff #2 to engage in inappropriate behavior. Staff #2 observed the incident and the children were separated. Parents were contacted immediately and notified of the situation. Staff #2 and Director did speak with child #2 and #3 regarding the incident. At the time incident, there were two staff # 1 and #2 in the classroom supervising 16 children. After the incident, Director instructed staff to monitor and shadow child #2. LPA was advised there have been no further incidents between the two children.

The Notice of Site Visit (LIC9213) in LPA's presence.

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: 07/21/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2017
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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