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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701281
Report Date: 05/22/2023
Date Signed: 08/03/2023 12:55:21 PM


Document Has Been Signed on 08/03/2023 12:55 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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108



FACILITY NAME:ALCOTT PRESCHOOLFACILITY NUMBER:
376701281
ADMINISTRATOR:STEPHEN LEWISFACILITY TYPE:
850
ADDRESS:4680 HIDALGO AVENUETELEPHONE:
(619) 605-1200
CITY:SAN DIEGOSTATE: CAZIP CODE:
92117
CAPACITY:24CENSUS: 15DATE:
05/22/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Stephen LewisTIME COMPLETED:
03:15 PM
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On 5/22/23 at 1:10 PM, Licensing Program Analyst (LPA) Adrian Mangina conducted an unannounced case management visit to follow up on a self reported unusual incident reported by the facility on 4/17/23. Upon arrival, LPA was directed to the classroom and later met with Principal Stephen Lewis. Census was 15 children in the classroom with 4 staff members. LPA observed appropriate capacity, ratios and supervision while at the facility.

The incident occurred on 4/10/23 when a three year old child stepped on an adaptive stool in the bathroom and fell onto the toilet seat hitting chin. Census on the day of the incident was 15 children with four staff members. During this visit, LPA interviewed four teachers and inspected the bathroom. LPA learned that there was a staff member, Martha Rivera in the bathroom with the child at the time of the accident and was just more than an arm's length away and was unable to catch the child during the fall. LPA observed that the stool has been removed. THe child has returned to facility. It appears to have been an unfortunate accident. No further follow up needed.

No deficiencies were cited at this visit.

Exit interview conducted and report was reviewed with Principal Stephen Lewis. Notice of Site visit was provided and must remain posted for 30 days. Failure to post the LIC9213 Notice of Site Visit may result in a a $100 civil penalty.
SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Adrian L ManginaTELEPHONE: (619) 629-6197
LICENSING EVALUATOR SIGNATURE:
DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/22/2023
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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