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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105046
Report Date: 02/01/2023
Date Signed: 02/01/2023 04:24:41 PM

Document Has Been Signed on 02/01/2023 04:24 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:PRIMROSE SCHOOLS 4S RANCHFACILITY NUMBER:
376105046
ADMINISTRATOR:BREEANNA MOTAFACILITY TYPE:
850
ADDRESS:17025 VIA DEL CAMPOTELEPHONE:
(858) 592-2335
CITY:SAN DIEGOSTATE: CAZIP CODE:
92127
CAPACITY: 164TOTAL ENROLLED CHILDREN: 53CENSUS: 50DATE:
02/01/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Breeanna Mota, Licensee/Reena DayalTIME COMPLETED:
04:40 PM
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On 2/01/2023 at 2:55pm, Licensing Program Analyst (LPA) Selina Siao conducted an unannounced case management visit to follow-up on two incidents involving the preschool program regarding an injury incident. Upon arrival, LPA met with Director Breeanna Mota who was in the office. Six classrooms were toured and appropriate ratios were observed. All staff members present has the required background clearances and are associated to the facility.

Both incidents were self reported by the facility and a written report was received in the Licensing office within the required seven days reporting period. The facility was within ratio in both incidents. The first incident occurred on 1/12/2023 at the playground around 11am. The child attends the Early Preschool Class #1 and he tripped while running on the playground and rubbed his bottom lip and his lower face on the playground floor. Per Director during the incident there were two staff members supervising nine children. The incident resulted in the skin peeling from his lower lip and a small amount of blood to his nose. Staff washed the child's hands and face and applied ice pack to the area. The child did return to care without restrictions. LPA inspected the playground today and based on information obtained, the incident appears accidental, the facility took prompt action by administering first aid and notifying the parent. The child was taken to the doctor as a precaution by the parent. No treatment was provided to the child.

The second incident occurred on 01/13/2023 at the older preschool playground around 4:45pm. While child #1 was walking over to the bench area near the playground entrance door, his friend child #2 suddenly run up to him and push child #1 in hopes to get him to continue to play. Child #1's sustained a bump and a small cut on the back of the head as a result of him hitting his head on the concrete wall near where he was standing.

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2023
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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: PRIMROSE SCHOOLS 4S RANCH
FACILITY NUMBER: 376105046
VISIT DATE: 02/01/2023
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Per Director, there were 2 staff members supervising 15 children when the incident happened. Another staff was attending to a child at the restroom. The incident was observed by child #1, #2 parent and staff as it was during pick up time. First aid was administered promptly by staff member. The child did not obtain medical treatment and continue to be in care. In addition, staff discussed classroom safety rules with children in care. LPA inspected the area today. Licensee has purchased some plywood and is planning to cover to wall to ensure children's safety.

Exit interview conducted with the director and licensee. No citation issue. Notice of site visit was posted and it must remain posted for 30 days.

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023
LIC809 (FAS) - (06/04)
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