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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700136
Report Date: 02/20/2020
Date Signed: 02/20/2020 11:15:18 AM

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:LMSVSD-MARYLAND AVENUE SMART STEPSFACILITY NUMBER:
376700136
ADMINISTRATOR:KELLI NELSONFACILITY TYPE:
850
ADDRESS:5400 MARYLAND AVENUETELEPHONE:
(619) 668-5744
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY:24CENSUS: 20DATE:
02/20/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Chrisy Crumpton, Facility RepresentativeTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA), Marie Hernandez, conducted the case management inspection due to an incident that occurred on 01/29/2020. On 01/29/2020 at 9:30 AM, the facility self reported an incident that occurred between child #1 and child #2. Child #1 was hit in the face by child #2 with a plastic sand bucket. Child #1 and child #2 were playing in the sand when child #2 hit child #1 with the bucket. Child #1 sustained a wound to the lip and hitting the two front teeth. The teacher, Ms. Chrisy Crumpton, immediately tended to child #1's needs and contacted the parent. Child #1 received medical attention with no further incident. Through the course of the incident inspection and the interviews conducted, the incident was an accident. Child #1 and child #2 stated it was an accident and not intentional. The facility was proactive in handling the matter with child #1 and child #2. At time of incident, there were twenty four children with two teachers and one aide. Child #1 and child #2 stated the teacher, Ms. Chrisy, witnessed the incident. The teacher stated she was with child #1 and child #2 at time of incident.

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 Representative, Chrisy Crumpton. LPA observed the Representative post the Notice of Site Visit in a prominent place. The Representative 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: 02/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2020
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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