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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372002475
Report Date: 12/10/2020
Date Signed: 12/10/2020 12:18:37 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:ST. PETER'S PRESCHOOLFACILITY NUMBER:
372002475
ADMINISTRATOR:DENISE DUIMFACILITY TYPE:
850
ADDRESS:1371 SUNSET CLIFFS BOULEVARDTELEPHONE:
(619) 224-1689
CITY:SAN DIEGOSTATE: CAZIP CODE:
92107
CAPACITY:50CENSUS: DATE:
12/10/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Dori HoadleyTIME COMPLETED:
11:45 AM
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On December 1, 2020 at 01:30 PM Licensing Program Analysts (LPA), Adrian Castellon and Cindy Meier conducted an unannounced Tele-Conference Case Management Inspection. Due to the COVID -19 State of Emergency, the inspection was conducted via FACETIME. LPAs met with director Hoadley and discussed the purpose of the videocall. On 11/20/2020, the facility self reported an unusual incident to the SDCCRO. The facility reports that on 11/19/2020 at 12:30 PM, a 4 year old child #1 was playing on the appropriate age monkey bars when she fell off onto rubber matting. The child landed on her left arm under her back. The child's fall was not observed by facility staff as the staff member who was out on the playground had turned her back to tend to another child. The assistant was no more than 5 feet away from the child who fell. Through the course of the incident review, LPA inspected the playground where the incident occurred and conducted interviews with 3 facility staff and a child in care. On the day of the incident, there were six preschoolers with one staff member on the playground. The staff immediately tended to child’s and applied first aid. The child was taken to the office and her parents were immediately called. Parents live a few houses down from the facility so they arrived promptly. The child was taken to the emergency room and the arm was reset. The child returned to the facility with no further incident. This concludes the incident review. No deficiency cited. LPA Castellon discussed the case management incident inspection report, and the director stated she 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: Joe CarrascoTELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Adrian CastellonTELEPHONE: (619) 767-2237
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2020
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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