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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700944
Report Date: 10/23/2024
Date Signed: 10/23/2024 02:03:20 PM

Document Has Been Signed on 10/23/2024 02:03 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:URBAN VILLAGE 1 EARLY LEARNING ACADEMYFACILITY NUMBER:
376700944
ADMINISTRATOR/
DIRECTOR:
MARIANA CASTROFACILITY TYPE:
850
ADDRESS:3795B FAIRMOUNT AVENUETELEPHONE:
(619) 283-2780
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY: 80TOTAL ENROLLED CHILDREN: 80CENSUS: 50DATE:
10/23/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:30 AM
MET WITH:Lead Teacher Yolanda MartinezTIME VISIT/
INSPECTION COMPLETED:
09:00 AM
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On October 23, 2024, at 7:30 AM, Licensing Program Analyst (LPA) Jo Ann Legaspi conducted a case management inspection to follow-up on an incident that occurred on 10/17/2024. LPA advised Staff Tsheya Tirusew of the meeting’s purpose and was granted facility entry. Lead Teacher Yolanda Martinez provided LPA with a facility tour.

A child sustained an injury and required medical treatment on 10/17/2024. The incident was self-reported by the facility; the written report was received in the Licensing office within the required reporting period. There were about 25 children with 7 staff during the incident. On 10/17/2024, at about 9:30 AM, children were playing outside. A child was seated under the slide when they stood up and struck their head on this play structure. Staff observed the event, cleaned the child’s wound and contacted the parent. LPA interviewed staff and a daycare parent. LPA inspected the play structure. No deficiencies cited.



LPA provided Staff Martinez with the “Public Playground Safety Handbook”, authored by the US Consumer Product Commission. LPA also provided Staff Martinez with the “Active Supervision” flier, authored by the Early Childhood National Center. Staff Martinez and LPA discussed playground safety protocols.


A notice of site visit was given to the facility representative and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Licensee/Appeal Rights (LIC 9058) was provided to Staff Martinez. Exit interview conducted and report was reviewed with the Lead Teacher Yolanda Martinez.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024
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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