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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105098
Report Date: 01/24/2024
Date Signed: 01/24/2024 05:34:18 PM

Document Has Been Signed on 01/24/2024 05:34 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:TIERRASANTA ELEMENTARYFACILITY NUMBER:
376105098
ADMINISTRATOR:ROBIN BRUSTFACILITY TYPE:
840
ADDRESS:5450 LA CUENTA DRIVETELEPHONE:
(858) 496-8255
CITY:SAN DIEGOSTATE: CAZIP CODE:
92124
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 40DATE:
01/24/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Robin BrustTIME COMPLETED:
03:10 PM
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On 1/24/24 at 2:05 PM, Licensing Program Analyst (LPA) Keturah Lane conducted an unannouced case management visit to follow up on an unusual incident that happened on 12/11/23. Upon arrival, LPA was greeted by Director Robin Brust and toured the facility. LPA observed 40 children in the auditorium (the only room in use at the time) with 6 staff members including Director.

LPA toured the playground structure where the incident happened and observed there was sufficient cushioning in the area of the parallel bars. Playground structure is age-appropriate for children 5 years of age and up. Director stated there were 6 staff with 49 children on the playground on 12/11/23 and facility was within ratio. The incident happened right in front of the teacher supervising (Dayna Gomez) and was unavoidable. The 5-year old child was holding themselves up on the parallel bars, slipped and banged the elbow on the bars on the way down to the ground resulting in a fracture. Facility provided first aid to the child and then immediately reported the incident to the parent and Licensing. Written report was received by the Department on 12/12/23. Child recovered and returned to facility on 12/13/23. LPA Lane followed up with facility via e-mail on 12/15/23.

It appears that it was an accident that was not preventable. Director stated that they do not allow the children on the monkey bars and have a staff member near the parallel bars when in use. LPA observed the parallel bars to be less than 4 feet off the ground.
There were no deficiencies cited as a result of the unusual incident.

Exit interview conducted and report was reviewed with facility representative Director Robin Brust. A notice of site visit was provided and must remain posted for 30 days.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2024
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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