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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700787
Report Date: 06/19/2019
Date Signed: 06/19/2019 02:56:47 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:ECS 4TH AND D HEAD STARTFACILITY NUMBER:
376700787
ADMINISTRATOR:MELISA RUGAMAFACILITY TYPE:
850
ADDRESS:385 D STREETTELEPHONE:
(619) 591-9136
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY:37CENSUS: 0DATE:
06/19/2019
TYPE OF VISIT:Case Management - IncidentANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Nerissa Torralba, DirectorTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) D. Sanchez, made an unannounced follow up Case Management inspection to the facility today in response to an Unusual Incident/Injury Report received in the San Diego Child Care Regional Office (SDCCRO) on 5/01/2019. Incident report states that on 4/23/2019, during outdoor play child #1 was walking next to the sandbox, tripped and fell, hitting bottom and crotch area.

LPA inspected playground area where incident occurred. Area is clear and there are no tripping hazards. LPA also interviewed facility staff during today's inspection.

LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

There are no deficiencies cited on this incident, all paperwork is in order and required documents were properly posted.

Community Care Licensing WEB SITE: http://www.ccld.ca.gov

An exit interview was conducted with Nerissa Torralba and a copy of this report left at the facility.

LPA observed provider placing the Notice of Cite Visit on the wall visible to parents during today’s inspection.
NOTICE OF SITE VISIT MUST BE POSTED FOR 30 DAYS
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Diana SanchezTELEPHONE: (619) 767- 2210
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2019
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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