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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370800939
Report Date: 11/01/2022
Date Signed: 11/01/2022 04:01:25 PM

Document Has Been Signed on 11/01/2022 04:01 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:CHARLEY BROWN CHILDREN'S CENTERFACILITY NUMBER:
370800939
ADMINISTRATOR:ELIZABETH CORTESEFACILITY TYPE:
850
ADDRESS:5921 JACKSON DRIVETELEPHONE:
(619) 463-5126
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY: 94TOTAL ENROLLED CHILDREN: 94CENSUS: 46DATE:
11/01/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:37 PM
MET WITH:Katie Wendt, Facility RepresentativeTIME COMPLETED:
04:00 PM
NARRATIVE
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On November 1, 2022 at 2:37 PM, Licensing Program Analyst (LPA) Marie Hernandez, conducted an unannounced Case Management Inspection and met with the Facility Representative Katie Wendt. Present were forty six children with seventeen staff. On 09/19/2022, the Department received the incident report from the facility. The facility reports that on 09//12/2022 at 12:15 PM, that child in question was playing with her sibling when the sibling inadvertently pulled child in questions arm. LPA conducted several confidential interviews with the child in question, her sibling and the teacher (witness). The interviews revealed that the sibling inadvertently pulled child in questions arm. The teacher immediately tended to child in questions needs and applied ice directly to the area of pain around child's elbow. The parent was contacted and took child to the doctors. The child in question was diagnosed with nursemaid elbow. It has been determined that the incident was an accident. The teacher observed the incident and child's sibling inadvertently pulled child's arm. This concludes the incident review.

An exit interview was conducted and LPA Marie Hernandez explained the case management inspection report. The Facility Representative was provided the facility evaluation report, appeals rights and the notice of site visit. The Representative was advised that the notice of site visit must be posted in a prominent place for 30 days.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Marie Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2022
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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