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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372001014
Report Date: 11/06/2019
Date Signed: 11/06/2019 02:43:29 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:LEUCADIA CHILDREN'S SCHOOLFACILITY NUMBER:
372001014
ADMINISTRATOR:TORRES, ALICIAFACILITY TYPE:
850
ADDRESS:1337 NORTH VULCANTELEPHONE:
(760) 753-8084
CITY:LEUCADIASTATE: CAZIP CODE:
92024
CAPACITY:44CENSUS: 23DATE:
11/06/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Director Alicia TorresTIME COMPLETED:
02:50 PM
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Licensing Program Analyst, Joelle Redding, made an unannounced visit to follow up on a self reported incident that occurred on 10/25/19, wherein a 5 year old child (Child #1) fell off the fence rail and broke her wrist.


LPA spoke with the Director and Staff #1 who were on the playground when the incident occurred. Director stated that she was in the back of the sandbox between the swings and the fence putting down water on the sand for the kids. Staff #1 was in the front of the swingset, closer to the front fence rail and near the climbing structure. There were approximately 10 to 12 children present at the time. Child #1 and two or three other children were playing tag in the far corner near the play structure when Child #1 suddenly ran from the group toward the other end of the sandbox behind the play castle. Staff #1 said that she heard Child #1 start crying and immediately went to her. Child #1 was holding her arm and told Staff #1 that she jumped off the fence rail. Child #2 who was running with her, verified that information to Staff #1 when she asked him. Director stated that she took Child #1 inside for assessment and contacted her parent for pick up right away. LPA spoke with Child #1 who verified that she climbed the railing and fell on her arm. LPA also spoke with Child #2 who witness the incident. He confirmed Child #1's statement. Child #1 has since returned to school.

Director stated that the incident occurred in the late afternoon on Friday and she left a message for Licensing in the afternoon the following Monday, 10/28. She followed up the next morning.

No immediate hazards were noted upon evaluation of the sandbox area. Ratio were in place. LPA advised supervision should cover the entire playground in case a child separates from a group such as Child #1 did at the time of the incident.

No deficienices are cited at this time.
SUPERVISOR'S NAME: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019
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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