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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372006237
Report Date: 08/15/2022
Date Signed: 08/15/2022 11:05:55 AM


Document Has Been Signed on 08/15/2022 11:05 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:GRACE LUTHERAN PRESCHOOLFACILITY NUMBER:
372006237
ADMINISTRATOR:BRE MANATAFACILITY TYPE:
850
ADDRESS:643 W. 13TH AVETELEPHONE:
(760) 747-3029
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY:155CENSUS: 0DATE:
08/15/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:52 AM
MET WITH:Darlene Beebe, DirectorTIME COMPLETED:
11:15 AM
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On August 15, 2022 at 9:57 am, Licensing Program Analyst (LPA) Cindy Hamilton conducted an unannounced case management inspection at Grace Lutheran Preschool (CCC) to follow-up on an Unusual Incident Report (UIR) submitted by the CCC on July 21, 2022. During the inspection, LPA toured the facility and met with Site Director Darlene Beebe to discuss the reported incident. At the time of the inspection there were no children and minimal staff present. LPA interviewed the Director and reviewed pertinent files during this inspection.

On July 21, 2022, Community Care Licensing (CCL) received information via UIR that one child was dancing in the classroom and fell over on top of another child who was playing on the floor. This resulted the child who was on the floor having a right elbow fracture.

Due to the need obtain additional information and interview staff, LPA will need to conduct an additional visit to the CCC.

An exit interview was held with Director Darlene Beebe. A copy of this report and appeal rights were issued, along with a Notice of Site visit. This report shall be public record for three years.
SUPERVISOR'S NAME: Carlos MartinezTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Cindy HamiltonTELEPHONE: (951) 295-2190
LICENSING EVALUATOR SIGNATURE:
DATE: 08/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/15/2022
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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