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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700037
Report Date: 02/21/2020
Date Signed: 02/21/2020 12:40:47 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:CALVARY CHRISTIAN ACADEMYFACILITY NUMBER:
376700037
ADMINISTRATOR:JENNIFER GREENAWALDFACILITY TYPE:
850
ADDRESS:1771 EAST PALOMAR STREETTELEPHONE:
(619) 591-2260
CITY:CHULA VISTASTATE: CAZIP CODE:
91913
CAPACITY:120CENSUS: 68DATE:
02/21/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Assistant Director Malia KentTIME COMPLETED:
12:38 PM
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On February 21, 2020, at 11:10 AM, Licensing Program Analyst (LPA) Jo Ann Legaspi conducted a case management inspection to follow-up on an incident that occurred on 02/06/2020. LPA advised Assistant Director (AD) Malia Kent of the inspection’s purpose and they granted LPA facility entry. AD Kent provided LPA with a facility tour.

The following ratios were observed in the following classrooms: Room 114/PreK3A had seventeen children supervised by two teachers. Room 113/PreK3B had seventeen children supervised by two teachers. Room 111/Prek4A and Room 112 PreKB were empty because these children were outside at recess. The 2 Year Olds' classroom had nine children supervised by two teachers and one assistant. LPA observed the children to be involved in indoor and outdoor activities. Appropriate ratios were maintained, and visual observation noted.

A child sustained an injury and required medical treatment on 02/06/2020. The incident was self reported by the facility and a written report was received in the Licensing office within the required reporting period. There were 17 children with 4 staff during the incident. On 02/06/2020, at about 10:35 AM, the child slid down a slide and fell onto their side upon reaching the bottom the slide. The child did not present to be in distress or apparent pain. The parent later informed staff that they had taken to their child to the physician for medical care.

During today’s visit, LPA inspected the playground, slide in issue, observed children and interviewed staff. No deficiencies cited.




SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: JoAnn R LegaspiTELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020
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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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: CALVARY CHRISTIAN ACADEMY
FACILITY NUMBER: 376700037
VISIT DATE: 02/21/2020
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Staff was provided with A Notice of Site Visit (LIC 9213), which is to be posted for thirty (30) days. An exit interview was conducted with AD Kent. Licensee Rights (LIC 9098 01/16) along with a copy of this report was provided to staff and their signature on this form confirms receipt of these rights.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: JoAnn R LegaspiTELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020
LIC809 (FAS) - (06/04)
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