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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700816
Report Date: 12/15/2021
Date Signed: 12/15/2021 04:15:44 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:DISCOVERY ISLE - LA COSTA - SCHOOL-AGEFACILITY NUMBER:
376700816
ADMINISTRATOR:SUMMER CHANTHABOUASYFACILITY TYPE:
840
ADDRESS:1655 S RANCHO SANTA FE RD #101TELEPHONE:
(760) 752-8691
CITY:SAN MARCOSSTATE: CAZIP CODE:
92078
CAPACITY:42CENSUS: 2DATE:
12/15/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Summer ChanthabouasyTIME COMPLETED:
04:20 PM
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On December 15, 2021 at 2:25 p.m. Licensing Program Analyst, Leilani Curtis, conducted an unannounced inspection to follow up on a self-reported incident that occurred on 11/30/21 wherein a child (C1) was climbing on play equipment when she slipped and fell. Upon arrival LPA met with Director Summer Chanthabouasy and proceeded to tour the facility. There were 2 children with one staff member present. Appropriate ratio/capacity were observed. Staff members have the required background clearances and are associated to the facility.

LPA interviewed Staff #1, Staff #2, Child #1, Asst. Director (D1) and the Director. On 11/30/21 at approximately 4:45 p.m. C1 was climbing on the blue bridge/climbing wall of the play structure when she slipped, fell and landed on the sand below the structure, hurting her right arm. The play structure is made of plastic and is age appropriate. There is sand cushioning below the play structure. At the time of the incident there were 19 children and 2 staff members present on the playground. The director states that the school age program was sharing the playground with their private kindergarten program. Proper ratio and supervision were in place. As soon as the incident occurred D1 consoled the child and applied ice to her arm. The parent of C1 was notified of the incident and picked up the child. C1 went to the doctor where she was diagnosed with a fractured right arm and placed into a cast. The child returned to the facility on 12/2/2021 and remains in care. The director states that staff spoke to the children about playground safety and the proper use of playground equipment. The director also states that she has obtained bids for additional sand to be added to the playground. The facility responded appropriately and reported timely.

No deficiencies are cited.

An exit interview was conducted with the director and appeal rights (LIC 9058 1/16) were discussed. The director’s signature on this form acknowledges receipt of these rights. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA observed the director post notice of site visit.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
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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