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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701037
Report Date: 09/19/2019
Date Signed: 09/19/2019 11:46:25 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:NORTH COUNTY JEWISH PRESCHOOLFACILITY NUMBER:
376701037
ADMINISTRATOR:NECHAMA GREENBERGFACILITY TYPE:
850
ADDRESS:1930 SUNSET DRIVETELEPHONE:
(760) 806-7765
CITY:VISTASTATE: CAZIP CODE:
92081
CAPACITY:55CENSUS: 14DATE:
09/19/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Nechama GreenbergTIME COMPLETED:
10:45 AM
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A case management visit was conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on **8/30/2019**. It indicates a daycare child was playing in the playground area and fell face down on 8/28/2019 resulting in lacerations to the forehead as a precaution, paramedics were called to assess for potential serious head injury.

A physical plant inspection was conducted. The playground was inspected and appears to be a safe and age appropriate activity space for children in care. There were no visible signs of hazardous debris and playground equipment appears orderly, sturdy and in good condition. Based upon LPA inspection, no violations of Title 22 Regulations regarding physical plant, have been identified. Staff on duty during the time of the incident, applied first aid and ensured children safety. The parent was contacted immediately and the incident was reported timely.

No deficiencies cited.

An exit interview was conducted with Director Nechama Greenberg and a copy of this report was provided.

SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Otsanya CameronTELEPHONE: (951) 970-1388
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2019
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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