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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701235
Report Date: 05/10/2019
Date Signed: 05/10/2019 03:22:30 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:CONCORDIA CHURCH & SCHOOLFACILITY NUMBER:
376701235
ADMINISTRATOR:AARON PARTCHFACILITY TYPE:
840
ADDRESS:1695 DISCOVERY FALLS ROADTELEPHONE:
(619) 656-8100
CITY:CHULA VISTASTATE: CAZIP CODE:
91915
CAPACITY:90CENSUS: 35DATE:
05/10/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Aaron PartchTIME COMPLETED:
03:30 PM
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LPA GLoria Cruz made an unannounced visit to the facility and met with Director Aaron Partch. Purpose of the visit was to complete follow up regarding incident that was self reported on April 2, 2019 where Child #1 (Confidential Name List provided to Director) fell on playground after bumping into another child. Incident was originally called in by Director on 4/2/19 indicating witness was Teacher #1. The written Incident Report listed three staff supervising child. Child was intercession student and not available to be interviewed. Child #1 was taken to the hospital after being picked up as he complained of pain. Child's arm was fractured.

LPA interviewed all staff listed on Incident Report, none of the staff witnessed the incident. LPA discussed with Director the need for visual supervision at all times, especially during outdoor play. Although incident seems to have been an accident, there were no witnesses as stated in incident report.

No deficiencies are cited at this time.

NOTICE OF SITE VISIT MUST BE POSTED FOR 30 DAYS


SUPERVISOR'S NAME: Jason GarayTELEPHONE: (559) 767-2250
LICENSING EVALUATOR NAME: Gloria CruzTELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2019
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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