370805765-10-21-2021-20-CC-CTIY-C7ZTKG-20211021144756

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 370805765
Report Date: 10/21/2021
Date Signed: 10/21/2021 02:48:45 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:	INTERNATIONAL PRE-SCHOOL		FACILITY NUMBER:	370805765
ADMINISTRATOR:	FLORES, FE		FACILITY TYPE:	850
ADDRESS:	5940 WINCHESTER STREET		TELEPHONE:	(619) 479-2410
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92139
CAPACITY:	42	CENSUS: 15	DATE:	10/21/2021
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	01:51 PM
MET WITH:	Elenita Diesta		TIME COMPLETED:	02:50 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	On 10/21/2021 at 1:51 PM, Licensing Program Analyst (LPA) Crystal Tillory made an unannounced visit to follow up on a self reported incident on 9/8/2021 wherein a 4 year old child hurt her neck playing outside, sustaining a neck injury and needing to wear a neck brace. There are currently 15 children in care with three staff; children were napping during LPA's visit. At today's visit, LPA interviewed child #1. Child #1 understands the difference between a truth and a lie based on color examples. Child #1 stated on the day of the incident, she was playing on the monkey bars and she jumped up and missed the bar and fell down on her neck. Child #1 showed me a tiny scratch on her left arm that she says she also sustained during her fall. Child #1 stated she went home with her mom after she fell down and went to the doctor and had to wear a neck brace. Child #1 stated she loves coming to school and she loves playing on the monkey bars. Child #1 stated she is feeling all better now. Child #1 returned to class 2 days later wearing a soft neck brace. LPA interviewed administrator who stated the child is in a classroom of 8 children with Teacher #1. Teacher #1 was outside with the children the day of the incident and watching about 6 kids at the time. Child #1 was laying her head down on her desk after playtime and said her neck hurt. Teacher immediately called parent who picked the child up 30 min. later. Administrator stated the child was only out for 2 days and returned to class the following Monday. Teacher #1 has already gone home for the day and is unable to be interviewed at this time. LPA viewed the play area outside where child #1 fell and playground equipment is in good condition and age appropriate. No obvious hazards were noted. The outdoor play areas for the different classes are very close together so the other teachers can see what is going on in the other classes outdoor play time.

SUPERVISOR'S NAME: Cynthia Gray	TELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Crystal Tillory	TELEPHONE: 619-767-2216
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021

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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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: INTERNATIONAL PRE-SCHOOL	FACILITY NUMBER: 370805765
	VISIT DATE: 10/21/2021

NARRATIVE

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It appears this is an isolated incident. Ratios were met, supervision was in place, staff responded appropriately, and facility reported timely.

No deficiencies were cited.

A copy of this report along with appeal rights and LIC 9213 Notice of Site Inspection were provided to the administrator. This report shall be made available to the public upon request. LIC 9213 Notice of Site Inspection is required to be posted for 30 days.

Exit interview conducted with Administrator, Elenita Diesta.

SUPERVISOR'S NAME: Cynthia Gray	TELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Crystal Tillory	TELEPHONE: 619-767-2216
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021

LIC809 (FAS) - (06/04)

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