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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370806460
Report Date: 04/22/2021
Date Signed: 04/22/2021 01:29:02 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:AKA HEAD START - LA MESAFACILITY NUMBER:
370806460
ADMINISTRATOR:OHLY, ROWENAFACILITY TYPE:
850
ADDRESS:7520 EL CAJON BLVD STE 201/203TELEPHONE:
(619) 463-1093
CITY:LA MESASTATE: CAZIP CODE:
91941
CAPACITY:60CENSUS: 10DATE:
04/22/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Rowena Ohly, Facility DirectorTIME COMPLETED:
12:30 PM
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On April 22, 2021 at 11:30 AM, Licensing Program Analyst (LPA), Marie Hernandez, conducted an unannounced Tele-Conference Case Management Inspection due to the COVID -19 State of Emergency via Facetime with the Facility Director, Rowena Ohly. The facility self reported the incident to the Department. The facility reports that on 04/19/2021 at approximately 10:30 AM, child #1 tripped over the curb outside on the playground while playing and fell on his face. The Director stated child #1 sustained scrapes on his nose and right knee but with no bruising. Staff #1, staff #2 and staff #3 were with nine children in the play yard when the incident occurred. The parent was contacted and the child did not require any medical attention.

LPA conducted several interviews with the staff, and child #1. The Director stated child #1 returned to the facility the next day after the incident. As per the interviews with child #1, he tripped on his own feet and the staff stated they observed child #1 had tripped on his own feet and lost his balance. The child stated his teacher saw him fall and applied an ice pack on his nose. Staff #1 and staff #2 stated they observed the incident and immediately tended to child’s needs. LPA inspected the facility and the play yard. The play yard is enclosed with a fence and gate. LPA did not observe any tripping hazards or safety issues in the play yard during the inspection. As per the interviews with child #1 and the staff, the incident was an accident. Child #1 tripped on his own feet. This concludes the incident review.

LPA Marie Hernandez explained the case management incident inspection report, and the Facility Director stated it was understood. An exit interview was conducted, and a copy of the report was emailed to the Director. The Director was advised that acknowledgement of the receipt of the report is to be received within 24 hours. NOTE on Facility Signature: SEE FILE FOR ACKNOWLEDGEMENT.
SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Marie HernandezTELEPHONE: (619) 767-2244
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2021
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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