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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372005155
Report Date: 01/16/2020
Date Signed: 01/16/2020 02:51:21 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:MESA COLLEGE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
372005155
ADMINISTRATOR:IDA CROSSFACILITY TYPE:
850
ADDRESS:7250 MESA COLLEGE DRIVETELEPHONE:
(619) 388-2812
CITY:SAN DIEGOSTATE: CAZIP CODE:
92111
CAPACITY:66CENSUS: 36DATE:
01/16/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Cynthia Carrillo, Lead Staff TIME COMPLETED:
03:00 PM
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Licensing Program Analysts (LPAs) Elizabeth Rivera and Nancy Diaz, made an unannounced visit to follow up on a self-reported incident that occurred on 11/19/19, wherein a 2 and a half year old child (Child #1) was convulsing and became unconscious. LPAs toured the facility and observed 36 children with 9 staff present.

LPAs spoke with the Lead Staff Cynthia Carrillo, Staff #1, Staff #2, and Staff #3 who were present at the facility when the incident occurred.  Cynthia stated that she was not present when the incident happened but went over to provide help.  Staff #1 provided immediate assistance and administered Epi-pen to the child. Staff #2 stated she was coming back from break and went over to assist when she heard message on the radio. Staff #3 was present when the incident occurred and got child when he fainted but took the other children back to the classroom.

LPAs reviewed child #1's record. Cynthia Carrillo provided LPAs a copy of the Incidental Medical Services Plan, a current LIC500, LIC610A, and sketch.   No immediate hazards were noted upon evaluation of the facility and playground.   Ratios were in place. 

No deficiencies are cited at this time

Based on information gathered, the facility acted appropriately and no violations have been identified. 
SUPERVISOR'S NAME: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Elizabeth RiveraTELEPHONE: (619) 767-2232
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2020
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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