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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600282
Report Date: 12/12/2019
Date Signed: 12/12/2019 04:22:37 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:NHA - BARBARA Y. FIELDING EARLY LEARNING ACADEMYFACILITY NUMBER:
376600282
ADMINISTRATOR:PAOLA CARBAJALFACILITY TYPE:
830
ADDRESS:841 SOUTH 41ST STREETTELEPHONE:
(619) 263-7761
CITY:SAN DIEGOSTATE: CAZIP CODE:
92113
CAPACITY:40CENSUS: 15DATE:
12/12/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Paola Carbajal, Facility DirectorTIME COMPLETED:
04:25 PM
NARRATIVE
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Licensing Program Analyst (LPA), Marie Hernandez conducted the unannounced case management inspection regarding an incident with a two year old child. LPA met with the facility director, Paola Carbajal. During today's inspection, there are fifteen children with four teachers. The facility self reported an incident that occurred on 12/05/2019 at 3:30 PM with the child in question sustaining an injury to the upper lip while playing outside on the play structure. LPA conducted several interviews with the staff and the child in question. The child in question is two years old and did not respond to the questions. The teacher, Tigest Worku, stated she observed the incident. The teacher stated the child in question was climbing up the play structure and child lost her balance. The teacher stated the child hit her mouth on the play structure and it bled. The teacher stated they tended to the child's needs and immediately contacted the parent. The parent took child for medical treatment. The child has since returned to the facility. LPA inspected the outdoor play area and the play structure for safety hazards. Per the interviews, it appears that the incident was an accident.

No deficiency cited today. An exit interview was conducted and a copy of the report and the Notice of Site Visit was provided to the Facility Director, Paola Carbajal. LPA observed the Director post the Notice of Site Visit in a prominent place. The Director states it is understood that this notice must be posted for 30 days.
SUPERVISOR'S NAME: Joe CarrascoTELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Marie HernandezTELEPHONE: (619) 767-2244
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2019
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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