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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370800939
Report Date: 09/11/2019
Date Signed: 09/11/2019 05:35:37 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: 59DATE:
09/11/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:46 PM
MET WITH:Elizabeth CorteseTIME COMPLETED:
05:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Vicky Williamson arrived at the facility to conduct a case management inspection to finalize two separate incidents. LPA met with Director, Elizabeth Cortese. There were 59 preschool children present with 11 staff members including 2 preschool children who were napping.

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 Jackson 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 to the right arm. 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 and permission slips. LPA reviewed records for child #1. LPA’s observation of the sign posted on the playground at Jackson Park provided proof that all play equipment located at the park is designed for children ages 5-12 years of age. Child #1 was 4 years of age during the time of the incident. Based on the information obtained and reviewed by LPA, it is determined that facility staff failed to ensure that child #1 was playing on age appropriate play equipment. LPA and Director discussed the importance of ensuring that playground equipment is age appropriate. Director stated that she understood.

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 reviewed records for child #1. Based on the information obtained child #1 sustained an injury, however it was determined that is was an accident. No deficiencies cited.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Vicky WilliamsonTELEPHONE: (619) 767-2214
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2019
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 3
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: CHARLEY BROWN CHILDREN'S CTR
FACILITY NUMBER: 370800939
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/11/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/11/2019
Section Cited

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Fixtures, Furniture, Equipment and Supplies.All play equipment and materials used by children shall be age-appropriate. Requirement was not met as evidenced by: Child #1 fell off of a play structure at Jackson Park and sustained an injury to the right arm. Based on LPA’s observation of the sign posted on the playground at Jackson Park, it was determined that all play equipment located at the park is designed for children ages 5-12 years of age. Child #1 was 4 years of age during the time of the incident. This poses a potential health and safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Vicky WilliamsonTELEPHONE: (619) 767-2214
LICENSING EVALUATOR SIGNATURE:
DATE: 09/11/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/11/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3
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: CHARLEY BROWN CHILDREN'S CTR
FACILITY NUMBER: 370800939
VISIT DATE: 09/11/2019
NARRATIVE
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See LIC809D for issued deficiencies. LPA reviewed this report with Director Elizabeth Cortese and an exit interview was conducted. The licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA observed Licensee post notice of site visit.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Vicky WilliamsonTELEPHONE: (619) 767-2214
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3