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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372005402
Report Date: 10/14/2022
Date Signed: 10/26/2022 09:38:05 AM


Document Has Been Signed on 10/26/2022 09:38 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 10/17/2022 02:09 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

NARRATIVE
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THIS IS AN AMENDED REPORT DELIVERED ON 10/26/22 at 9:05 AM
On 10/14/22 at 10:15 AM, Licensing Program Analyst (LPA) Keturah Lane conducted an unannounced case management visit to follow up on an unusual incident reported by the facility on 10/6/22. The incident which happened on 9/26/22 involved a child that fell on the playground resulting in injury. LPA advised Director that whenever a child receives medical treatment for a possible injury that it should be reported within 24 hours to the duty line.
Upon arrival, LPA Lane met with Director Barbara Radi and toured the facility. Census was 34 children in 4 classrooms with 7 staff members present. LPA observed proper supervision and facility was within ratio. LPA Lane observed the playground and took pictures of the area where the child fell and other areas. Playground equipment was observed to be in safe condition, free of sharp, loose or pointed parts. Director provided documentation on the playground equipment to LPA and it is appropriate for ages 2-12 years. The areas around or under the climbing areas are cushioned with material that absorbs a fall. LPA observed at one corner of the playground a watering hose on the ground and concrete strip as potential trip hazards but were not related to the incident. LPA advised Director to train staff to roll up the hose so that it is not spread out on the ground and to highlight the concrete strip so it is visible (as it is somewhat covered with sand and near the sand pit). Director rolled up the hose and found an appropriate storage solution while LPA was present. LPA interviewed the Director and staff member that witnessed the incident. LPA concluded that the child's fall was not a result of any hazards in the area and it was an unfortunate accident that was not preventable. There was appropriate supervision and care provided to the child at the time of the incident.
Pursuant to Title 22 of the CA Code of Regulations, the following Type B deficiency was cited (refer to LIC 809-D).
Exit interview conducted and report was reviewed with the facility representative Director Barbara Radi. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Keturah LaneTELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2022
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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Document Has Been Signed on 10/14/2022 12:25 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108


FACILITY NAME: CHRIST PRESBYTERIAN PRESCHOOL
FACILITY NUMBER: 372005402

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/14/2022
Section Cited

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101212 Reporting Requirements (d)Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. (B) Any injury to any child that requires medical treatment. This requirement was not met as evidenced by...
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Based upon Director interview, Director did not report incident to the Department timely which is a potential health, safety and personal rights risk to children.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Keturah LaneTELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:
DATE: 10/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2022
LIC809 (FAS) - (06/04)
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