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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370800939
Report Date: 07/19/2019
Date Signed: 07/19/2019 03:56:58 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:CHARLEY BROWN CHILDREN'S CTRFACILITY NUMBER:
370800939
ADMINISTRATOR:ELIZABETH CORTESEFACILITY TYPE:
850
ADDRESS:5921 JACKSON DRTELEPHONE:
(619) 463-5126
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY:94CENSUS: 56DATE:
07/19/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:31 PM
MET WITH:Elizabeth CorteseTIME COMPLETED:
04:05 PM
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Licensing Program Analyst (LPA) Vicky Williamson arrived at the facility to conduct a case management inspection to follow up on two separate incidents. LPA met with Director, Elizabeth Cortese. There were 56 preschool children present with 10 staff members.

On 7/1/19, the Director self- reported an incident that allegedly occurred on 6/28/19 at 11:30am while the children were at a nearby park on a field trip. Child #1 was observed by staff #1 jumping from the platform part of a play structure on the playground area of the park landing on the ground on the right side of his body onto the of top of the wood chips. Child #1 sustained an injury. The parents of child #1 were contacted and medical attention was obtained for the child. There were 21 children present during the time of the incident, 4 teachers and 1 aide. LPA conducted interviews with staff members and a day care parent. LPA unable to interview child #1. LPA obtained a copy of facility roster, sign in / sign out sheet and permission slips. LPA reviewed records for child #1. No deficiencies were issued at this time.

On 7/5/19, the Director self- reported an incident that allegedly occurred on 7/3/19. Child #1 was observed by staff #1 playing on the playground at the facility with a small ball. Child #1 was kicking the ball and lost her footing causing the ball to go behind her. Per staff #1, child #1 fell onto the asphalt on her right wrist. Ice was applied to the wrist of child #1 by staff #2. The parents of child #1 were contacted and medical attention was obtained for child #1. LPA conducted interviews with staff members. Child #1 was unavailable to be interviewed. LPA obtained a copy of facility roster and sign in /sign out sheets for 7/3/19. LPA reviewed records for child #1. No deficiencies were issued at this time.

Notice of Site Visit (LIC 9213) was provided to be posted at the facility for 30 days. LPA observed form LIC 9213 posted.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Vicky WilliamsonTELEPHONE: (619) 767-2214
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2019
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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