<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600490
Report Date: 08/28/2024
Date Signed: 08/28/2024 12:42:04 PM

Document Has Been Signed on 08/28/2024 12:42 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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:EASTLAKE COMMUNITY CHURCH PRESCHOOLFACILITY NUMBER:
376600490
ADMINISTRATOR/
DIRECTOR:		DINORAH JUAREZFACILITY TYPE:
850
ADDRESS:2351 OTAY LAKES ROADTELEPHONE:
(619) 421-4156
CITY:CHULA VISTASTATE: CAZIP CODE:
91915
CAPACITY: 174TOTAL ENROLLED CHILDREN: 163CENSUS: 97DATE:
08/28/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Dinorah JuarezTIME VISIT/
INSPECTION COMPLETED:
12:55 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 8/28/2024, at 9:15am., Licensing Program Analysts (LPAs) Vicky Williamson and Saul Zazueta conducted an unannounced case management inspection regarding a self reported incident. LPAs met with Director, Dinorah Juarez. LPAs discussed the purpose of the inspection and were led on a tour of the facility. There were 118 children present with 22 staff members.

Director reported that on 8/9/2024, Staff (S1) and Staff 2 (S2) were supervising five (5) children on the playground. S1 stated that she pushed the toy playhouse against the building and observed Child 1 (C1) run into the playhouse. In preparation for transition into the building, S1 stated that she called out to the children and had them hold on to the walking rope. Director stated that per video footage at 4:59pm S1, S2 and four (4) children began transitioning from the playground to the inside of the building. Director stated that after the classroom transitioned inside of the building, C1 was left unsupervised on the playground inside of the playhouse for approximately 4 minutes.

Interviews were conducted with the director, staff, and C1's authorized representative. S2 and C1 were unavailable for interview. LPA reviewed staff and children files, video footage and obtained copies of facility roster, sign in/sign out sheet, and related documentation. Interview conducted with S1 disclosed that upon entering the classroom and the arrival of C1’s authorized representative, it was determined that C1 remained on the playground without supervision. Per S1 and C1’s authorized representative C1 was retrieved from the playground and appeared safe and unharmed.

LPA's review of video footage during the time of inspection determined that C1 was left without supervision on the playground for approximately 5 minutes.

See LIC 809C Continuation...
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2024
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: EASTLAKE COMMUNITY CHURCH PRESCHOOL
FACILITY NUMBER: 376600490
VISIT DATE: 08/28/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Director stated that staff have been retrained on the protocol of counting children in their classroom before and after transitioning. Director and staff stated that an additional roster has been created for staff to document the time of pick, name to face procedures, and the number of children transitioning to and from the playground at all times.

Based on interviews, one (1) Type A deficiency of California Code of Regulations, Title 22, Division 12, Chapter 1, is being cited on the attached LIC 809D.

LPA informed Director, Dinorah Juarez that this report dated August 28, 2024 documents one (1) Type A citation, which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

An immediate civil penalty of $500 was assessed for absence of supervision.

Also, LPA informed Director, Dinorah Juarez to provide a copy of this licensing report dated August 28, 2024, that documents a Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. LPA provided Director, Dinorah Juarez with form LIC 9224.

A copy of this report along with the Appeals Rights (LIC 9058) were provided. A Notice of Site Visit was provided and is required to be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. LPA observed Director post Notice of Site Visit on the bulletin board in the lobby.



Exit interview was conducted with Director, Dinorah Juarez.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 08/28/2024 12:42 PM - It Cannot Be Edited


Created By: Vicky Williamson On 08/28/2024 at 11:42 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: EASTLAKE COMMUNITY CHURCH PRESCHOOL
FACILITY NUMBER: 376600490

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/06/2024
Section Cited
CCR
101229(a)(1)

1
2
3
4
5
6
7
101229 (a) The licensee shall provide care and supervision... (1) No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation.
This requirement is not met as evidenced by:

1
2
3
4
5
6
7
Director stated that staff has been retrained on supervision and transitioning. Director stated that staff will view the video Supervising Children in Child Care Centers on the CCLD website and submit a staff sign in sheet, summary of the video, and a written plan of action to the SDRO by 9/6/2024.
8
9
10
11
12
13
14
Based interview and record review, the licensee did not comply with the section cited above in that on 8/9/24, there was an absence of supervision resulting in C1 being left unsupervised on the playground which poses a immediate, safety, or personal rights risk to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Tulam Vu
LICENSING EVALUATOR NAME:Vicky Williamson
LICENSING EVALUATOR SIGNATURE:
DATE: 08/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/28/2024


LIC809 (FAS) - (06/04)
Page: 3 of 3