<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370800119
Report Date: 11/08/2019
Date Signed: 11/08/2019 12:21:05 PM

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:CHRISTIAN CHURCH OF LEMON GROVE PRESCHOOLFACILITY NUMBER:
370800119
ADMINISTRATOR:LEAVITT, LYNNFACILITY TYPE:
850
ADDRESS:6970 SAN MIGUEL AVENUETELEPHONE:
(619) 465-1887
CITY:LEMON GROVESTATE: CAZIP CODE:
91945
CAPACITY:90CENSUS: 21DATE:
11/08/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:31 AM
MET WITH:Lynn Leavitt TIME COMPLETED:
12:00 PM
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) Rajani Goudreau conducted an unannounced case management inspection for the purpose of following up on a self-reported incident submitted to the Department on 10/31/19. Upon arrival, LPA met with Director, Lynn Leavitt and proceeded to tour the facility. Facility is within proper ratio and capacity limitations.

During today's visit, LPA toured outdoor play area, conducted interviews with staff members and documentation was obtained relevant to incident. Information obtained from unusual incident report and interviews conducted reflects the following: On 10/24/19, child #1 (C1) was running across the outside patio and accidentally ran into a child ridding a tricycle. C1 fell landing on her bottom with both arms landing on the ground attempted to catch fall. Child ridding the tricycle did not fall. Staff #1 (S1) immediately tended to C1 and assessed the child for injuries. S1 did not observe any lacerations, bruising or swelling on the child. However, S1 observed child holding her right arm and crying. S1 applied ice to C1 right arm. After 10 minutes of the incident, C1 continued to cry and hold her right arm.  S1 called for back up. Director walked C1  to the office where C1 was re-examined for injuries. C1 continued to hold her right arm and cry. Director immediately called the child parents informing of the incident. Shortly after, child was picked up and taken to urgent care where C1 was diagnosed with a fractured arm. C1 received a cast and pins on right arm to ensure the child’s arm heals properly. Director indicated child returned to the center on 11/04/19 with restrictions to not play on the playground for the next couple of weeks until pins and cast are removed. Facility will no longer allow bikes to be used in the patio area and staff will continue to remind children to use walking feet in the patio and playground area.  LPA determined based on interviews conducted, supervision was in place, ratios were met, the facility responded appropriately. See LIC809-C continuation page...
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Rajani GoudreauTELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2019
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: CHRISTIAN CHURCH OF LEMON GROVE PRESCHOOL
FACILITY NUMBER: 370800119
VISIT DATE: 11/08/2019
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
26
27
28
29
30
31
32
Facility submitted LIC624-Unusual Incident/Injury Report to the Department on 10/31/19. Incident was not reported to the Department within 24 hours of the incident. LPA informed Director of the reporting requirements and time frames. Director acknowledges understanding of the reporting requirements and time frames.

No deficiencies were cited during today's visit. LPA conducted an exit interview with Director. LPA provided the following to Director: LIC809, appeal rights, LIC9213 - Notice of Site Visit. LPA informed Director LIC9213 must be posted for 30 days from today's date. LPA observed Director post  Notice of Site Visit prior to exiting facility.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Rajani GoudreauTELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2