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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600490
Report Date: 05/04/2022
Date Signed: 05/04/2022 03:04:56 PM

Document Has Been Signed on 05/04/2022 03:04 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:EASTLAKE COMMUNITY CHURCH PRESCHOOLFACILITY NUMBER:
376600490
ADMINISTRATOR:SHERRIANN KELLYFACILITY TYPE:
850
ADDRESS:2351 OTAY LAKES ROADTELEPHONE:
(619) 421-4156
CITY:CHULA VISTASTATE: CAZIP CODE:
91915
CAPACITY: 174TOTAL ENROLLED CHILDREN: 174CENSUS: 80DATE:
05/04/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Director - Sherri KellyTIME COMPLETED:
03:15 PM
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On 05/04/2022 at 1:40 PM, Licensing Program Analysts (LPA) Edgar Campana and Claudia Amador conducted a case management inspection regarding an incident that occurred on 04/18/2022. LPAs advised Director Sherri Kelly of the purpose of the inspection and were led on a tour of facility. Present during the inspection were 80 children and 16 staff.

On 04/19/2022, Facility self reported an Unusual Incident that occurred on 04/18/2022 where a daycare child fell while on a play structure in the playground and sustained dental injuries. Child's grandmother, who works at facility, took child home immediately and child was subsequently taken to the hospital.

LPAs interviewed director and the three staff members who were present in playground at time of incident. Staff members all indicated that incident occurred suddenly and was not the cause of foul play or neglect. Proper procedures were followed after child was injured and ratio was maintained in playground while injured child was taken to front office for treatment and transport.

LPAs inspected the play structure and playground. Play structure is in good working order and does not show signs of need for repairs, nor does it display any structural concerns. The playground was neat and orderly, and did not contain any hazardous items. No children were present in playground at time of inspection.

No deficiencies issued during today's visit. An exit interview was conducted with Director Sherri Kelly and the following was provided: LIC 809 and LIC 9213- Notice of Site Visit. LPA informed Director that LIC 9213 must be posted for 30 days from today's date.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Edgar Campana
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2022
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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