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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600162
Report Date: 09/30/2024
Date Signed: 09/30/2024 03:46:10 PM


Document Has Been Signed on 09/30/2024 03:46 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108



FACILITY NAME:MISSION NAZARENE PRESCHOOLFACILITY NUMBER:
376600162
ADMINISTRATOR:EVELYN KENSELFACILITY TYPE:
850
ADDRESS:4750 MISSION GORGE PLACETELEPHONE:
(619) 287-4900
CITY:SAN DIEGOSTATE: CAZIP CODE:
92120
CAPACITY:114CENSUS: 49DATE:
09/30/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Evelyn KenselTIME COMPLETED:
04:00 PM
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On 9/30/24 at 2:00 pm, Licensing Program Analysts, Gerald Poindexter and Mahjoba Raofi, made an unannounced visit to follow up on a self-reported incident that occurred on 9/11/24 at approximately 4:55 pm wherein Child #1 was injured falling from the playground slide equipment, sustaining an injury. Upon arrival, LPAs met with director Evelyn Kensel. LPAs toured the facility. There were 49 children present at naptime with 9 staff, in 5 rooms – #104 through #108. Facility is within ratio and capacity.

LPAs examined the area of the fall, inspected the equipment and surrounding cushioning, interviewed staff present at the time of the incident and Child #1. Child #1 described the incident as the facility reported it. There were 2 staff members with 11 children at the time of the incident.

Based upon information obtained today, staff supervision was present during the fall but was unable to intervene quickly enough to prevent it. The facility has appropriate cushioning, age-appropriate equipment, direct supervision was in place, ratios were met, and staff responded appropriately with first aid and limited the child’s activity. The extent of the injury was not immediately apparent and was not diagnosed until the next day. Subsequent to the incident, staff reinforced existing rules of safe play to children prior to each time they play – specifically “no walking up the slide.” Staff were also repositioned at all times at bottom of the slide.
No deficiencies are cited.

Exit interview was conducted and report was reviewed with director Evelyn Kensel. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Appeal rights were provided.

SUPERVISOR'S NAME: Joelle ReddingTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Gerald PoindexterTELEPHONE: 619-767-2201
LICENSING EVALUATOR SIGNATURE:
DATE: 09/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2024
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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