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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700393
Report Date: 12/01/2021
Date Signed: 12/01/2021 11:25:00 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:LINDA VISTA STATE PRESCHOOLFACILITY NUMBER:
376700393
ADMINISTRATOR:NINA MAURICA-DIXONFACILITY TYPE:
850
ADDRESS:2772 ULRIC STREETTELEPHONE:
(858) 800-5450
CITY:SAN DIEGOSTATE: CAZIP CODE:
92111
CAPACITY:24CENSUS: 21DATE:
12/01/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Athena GonzalesTIME COMPLETED:
11:40 AM
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On 12/1/21 at 9:00 AM, Licensing Program Analysts (LPAs) Keturah Lane and Daniel Pena conducted an unannounced case management incident to follow up on an incident that occurred in the classroom on 10/18/21. LPAs were escorted to classroom 30 on the Linda Vista Elementary school campus where the state preschool is licensed. Present in the classroom were 21 children with 6 staff members. LPAs were following up on an incident where a child's arm was stepped on and fractured.

LPAs observed children in circle time in the classroom and transitions to small groups. During this time LPAs interviewed 1 child and 4 staff members. Proper supervision and ratios were observed. LPAs did not observe any hazards or safety issues in the room. It appears that the incident was an accident and the facility followed proper reporting requirements for licensing and responded promptly and appropriately to the incident.

No deficiencies were cited. Exit interview was conducted and report was reviewed with staff member Athena Gonzales. Notice of site visit was provided and must remain posted for 30 days.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Keturah LaneTELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2021
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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