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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700727
Report Date: 03/11/2022
Date Signed: 03/11/2022 05:06:59 PM

Document Has Been Signed on 03/11/2022 05:06 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:KLASSIC KIDS HARDYFACILITY NUMBER:
376700727
ADMINISTRATOR:ELAINE ALMARIOFACILITY TYPE:
840
ADDRESS:5420 MONTEZUMA ROADTELEPHONE:
(619) 534-2845
CITY:SAN DIEGOSTATE: CAZIP CODE:
92115
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 32DATE:
03/11/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Elaine Gandy & Kristen GonzalezTIME COMPLETED:
03:30 PM
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On 3/11/22 at 2:50 PM, Licensing Program Analyst (LPA) Keturah Lane conducted an unannounced case management visit to follow up on an unusual incident that occurred on 1/5/22. Upon arrival LPA met with Site Director Elaine Gandy (Almario) and toured the facility. Census was 32 children with staff members: Elaine Gandy, Cynthia Bavaro and Natalia Espinosa present. LPA observed children doing activities inside the classroom and then transitioning to outdoor play and snack time. Klassic Kids Program manager Kristen Gonzalez arrived at 3:20 PM.

The incident on 1/5/22 involved an injury to a child (C1) who fell off a structure (monkey bars) in the playground area. Staff member saw C1 fall from the structure. C1 returned to playing and seemed fine. However, parents of C1 took child to urgent care later and confirmed collarbone had been broken. Child received clavicle splint and follow up appointment for 1/27/22. LPA Lane received report (LIC624) on 1/7/22 which stated the play structure is off limits for time being and staff will go over safety procedures.
LPA Lane followed up with facility on 1/28/22 via phone. Director stated the structure is not far from the ground and all play structures have turf cushion. Director stated they went over safety procedures with staff and children. At this point, Director had not received updated information on C1 from follow up appointment.

At 3:15 PM, LPA inspected playground area with Ms. Gonzales (program manager) and observed that fall distance was approximately 4 feet or less and playground had approval sticker on it for ages 5-12 years old. Playground area had thick rubber cushioning around entire playground structure. It appears that this was an unfortunate accident, children were being properly supervised at the time and equipment is in good repair with proper cushioning. All staff members have current Pediatric CPR/First Aid. Exit interview conducted and report was reviewed with facility representative, Kristen Gonzales. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2022
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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