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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700417
Report Date: 03/27/2023
Date Signed: 03/27/2023 05:07:09 PM


Document Has Been Signed on 03/27/2023 05:07 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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108



FACILITY NAME:SKYLINE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
376700417
ADMINISTRATOR:JACQUELINE SERRANOFACILITY TYPE:
830
ADDRESS:11330 CAMPO ROADTELEPHONE:
(619) 415-5485
CITY:LA MESASTATE: CAZIP CODE:
91941
CAPACITY:45CENSUS: 20DATE:
03/27/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH: Rosa JohnsonTIME COMPLETED:
05:10 PM
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On 3/27/2023, at 3:20 p.m., Licensing Program Analyst (LPA) Vicky Williamson conducted an unannounced case management inspection to follow up on two separate self - reported incidents. Upon arrival, LPA Williamson met with Director Jacqueline Serrano and Assistant Director Rosa Johnson. LPA discussed the purpose of the inspection and proceeded to tour the facility. There were six infants (6) in Room 301 with two (2) staff, six (6) infants in Room 306 with two (2) staff. LPA observed eight (8) infants from Room 316 on the playground with two (2) staff.

On 2/23/2023, the director self- reported an incident regarding an alleged possible lack of supervision involving Child 1 (C1). Per Director, the alleged incident occurred on 2/17/2023 at about 10:55 am.

On 2/23/2023, the director self- reported an incident regarding an alleged possible lack of supervision involving Child 2 (C2). Per Director, the alleged incident occurred on 2/212023 at about 10:55 am.

During today’s inspection, LPA conducted interviews with the director, staff and reviewed pertinent information.

No deficiencies cited during today’s inspection. An exit interview was conducted with Assistant Director Rosa Johnson and a copy of this report, Appeal Rights and Notice of Site Visit were provided. Notice of Site Visit is required to be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Vicky WilliamsonTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2023
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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