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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372000501
Report Date: 07/24/2024
Date Signed: 07/24/2024 10:05:50 AM

Document Has Been Signed on 07/24/2024 10:05 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:SAN CARLOS UNITED METHODIST WEEKDAY PRESCHOOLFACILITY NUMBER:
372000501
ADMINISTRATOR/
DIRECTOR:		WENDY KOZAFACILITY TYPE:
850
ADDRESS:6554 COWLES MOUNTAIN BOULEVARDTELEPHONE:
(619) 464-4335
CITY:SAN DIEGOSTATE: CAZIP CODE:
92119
CAPACITY: 122TOTAL ENROLLED CHILDREN: 122CENSUS: 68DATE:
07/24/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Wendy KozaTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
NARRATIVE
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On 7/24/24 at 8:30 AM, Licensing Program Analyst (LPA) Keturah Lane conducted a case management visit to follow up on an unusual incident that happened at the facility on 4/9/24. Child (C1) may have been injured on the playground and LPA went to the facility to follow up regarding the incident. Upon arrival, LPA met with Director Wendy Koza and toured the facility. LPA observed a total of 68 children in the following classrooms:
  • Classroom #1 had 6 children with staff members Rebecca Lekaunas and Clara Murray
  • Classroom #2 had 9 children with staff members Olivia Zito and Annalisa Sands
  • Classroom #3 had 5 children with staff members Valerie Zito and Maria Anaya
  • Classroom #5 had 11 children with staff members Erica Smithey-Wedel and Lisbeth Uriasvidano
  • Classroom #6 had 3 children with Jessica Blackston and Christina Quick
  • Classroom #7 had 8 children with staff members Emily Vazquez and Celene Gutierrez
  • Classroom #9 had 10 children with staff members Teresa Nguyen and Brianna Disabantonio
  • Classroom #10 had 9 children with staff members Chantilee Mendenhall and Avamarr Morrow
  • Classroom #11 had 7 children with staff members Breanna Cormier and Jenica Hendricks

(continued on LIC809-C....)
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: SAN CARLOS UNITED METHODIST WEEKDAY PRESCHOOL
FACILITY NUMBER: 372000501
VISIT DATE: 07/24/2024
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During this visit, LPA spoke with two staff that were present during the incident on 4/9/24. C1 was absent today and not available for LPA to interview. LPA spoke with C1's father on the phone regarding the incident. LPA also observed video of C1 leaving the facility and possibly limping. It could not be determined when the child may have been injured or if it occurred while jumping off the 3 feet high blocks that can be moved around the playground. LPA provided technical assistance and advised that staff to redirect the children to another activity when they are jumping off the blocks for safety reasons.

No deficiencies were cited during this inspection. Exit interview and report was reviewed with Director Wendy Koza. Notice of site visit was provided and must be posted for 30 days.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
LIC809 (FAS) - (06/04)
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