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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700250
Report Date: 12/02/2024
Date Signed: 12/02/2024 11:44:52 AM

Document Has Been Signed on 12/02/2024 11:44 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 CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:SBCS - MI ESCUELITAFACILITY NUMBER:
376700250
ADMINISTRATOR/
DIRECTOR:		MARIELA ARCE-HURTADOFACILITY TYPE:
850
ADDRESS:915 FOURTH AVENUETELEPHONE:
(619) 420-0116
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY: 96TOTAL ENROLLED CHILDREN: 96CENSUS: 23DATE:
12/02/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Director - Lisa KlempTIME VISIT/
INSPECTION COMPLETED:
12:10 PM
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On 12/02/2024 at 09:15 AM, Licensing Program Analyst's (LPA's) Julieta Abrego and Michelle Hood, made an unannounced visit to follow up on a self-reported incident that occurred on 10/29/2024, wherein a 3 year old fell from the monkey bars located on the playground. The child sustained an elbow fracture. LPA's met with the Director.

LPA's interviewed the Director and two staff. LPA's inspected and measured the monkey bar area where the injury occurred. LPA's obtained a copy of the volunteer and children's daily sign-in/sign-out sheet for 10/29/2024. LPA's obtained a copy of the children's roster and communication between director and parent.

Further investigation is needed on the incident that occurred on 10/29/2024. An exit interview was conducted and the report was reviewed with director Lisa Klemp. The director was provided a copy of the appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. Notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. No deficiencies were cited.
SUPERVISORS NAME: Cynthia Biszant
LICENSING EVALUATOR NAME: Julieta Abrego
LICENSING EVALUATOR SIGNATURE: DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/02/2024
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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