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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372000413
Report Date: 04/23/2019
Date Signed: 04/23/2019 11:34:07 AM

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:NORTHMINSTER PRESCHOOLFACILITY NUMBER:
372000413
ADMINISTRATOR:HARDER, SHELLIFACILITY TYPE:
850
ADDRESS:4324 CLAIREMONT MESA BLVD.TELEPHONE:
(858) 270-3760
CITY:SAN DIEGOSTATE: CAZIP CODE:
92117
CAPACITY:95CENSUS: 91DATE:
04/23/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Andree Webb, Assistant DirectorTIME COMPLETED:
11:45 AM
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LPA, Luigi Gargaro, conducted an unannounced case management visit to the facility today to follow up on a self reported facility incident in which child #1 fell off rings that are part of a facility play structure which resulted in her fracturing her arm.

During today's visit, facility director Shelli Harder was not present so analyst met with and interviewed assistant director Andree Webb to obtain her perspective on what occurred during the incident. Analyst also interviewed other staff members who were present and involved with the incident and reviewed the facility equipment where the incident occurred. Analyst was unable to interview the involved child as she is only a part time enrolled student.

Based on the testimony received today and equipment inspection, analyst determined that the child in question accidentally fell from the equipment and injured herself when landing awkwardly on the sand cushioned floor of the playground. Analyst found the equipment to be age appropriate (based on posted manufacturer's equipment age recommendation) and of a safe height and the play area's sand cushioning to be of sufficient depth and compactness. Analyst therefore found the incident that occurred to be accidental in nature.

No deficiencies were cited during today's visit. Analyst provided assistant director with a Notice Of Site visit to post for thirty days on their licensing information area before he left the facility today.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi GargaroTELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2019
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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