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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700534
Report Date: 09/08/2022
Date Signed: 09/08/2022 02:29:15 PM

Document Has Been Signed on 09/08/2022 02:29 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:PALOMAR FAMILY YMCA-HERITAGE CHARTER SCHOOLFACILITY NUMBER:
376700534
ADMINISTRATOR:ALEXIA CITALFACILITY TYPE:
840
ADDRESS:1855 EAST VALLEY PARKWAYTELEPHONE:
(760) 644-2185
CITY:ESCONDIDOSTATE: CAZIP CODE:
92027
CAPACITY: 60TOTAL ENROLLED CHILDREN: 28CENSUS: 0DATE:
09/08/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Patricia Gonzalez, Site SupervisorTIME COMPLETED:
02:40 PM
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A case management visit was conducted by Licensing Program Analyst's (LPA's) Linda Almaraz and Sumayya Habeebulla in response to an Unusual Incident report received. LPA's met with Patricia Gonzalez, Site Supervisor and notified her of the reason for today's visit. LPA's toured the field and not children were present at the facility.

Interviews were conducted with Gonzalez and Staff #1, who was present at the time of the incident. Per interviews conducted, on 05/23/22 at around 3PM they were outside in the field during play time when Child #1 was bumped by Child #2. Per interviews, Child #2 was walking backwards trying to catch a ball and accidentally bumped into Child #1 and caused Child #1 to fall. Staff #1 assessed Child #1 after the accident and provided an ice pack. No bruising or scrapping was visible but the child was in pain so the parent was called to pick up Child #1. Per Staff #1, who witnessed the fall there was nothing in the floor and Child #2 did not see Child #1 behind Child #2. Children were talked about safety and Child #1 was picked around 4PM. The child returned to the facility the following day with a splint and the mother informed the center, the child had obtained buckle fracture and needed to wear it for about 3 weeks.

Based on the information obtained during the visit, there appeared to be no violations of Title 22 Regulations pertaining to the reported incident. The facility took appropriate action and reported the incident to CCL

An exit interview was held. A Notice of Site visit was issued, along with a copy of this report. This report shall be public record for three years. Appeal Rights were also provided. No deficiencies cited at this time.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Linda M Almaraz
LICENSING EVALUATOR SIGNATURE: DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2022
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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