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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701396
Report Date: 07/11/2023
Date Signed: 07/11/2023 09:57:40 AM

Document Has Been Signed on 07/11/2023 09:57 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 N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:KINDERHOUSE MONTESSORI SCHOOLFACILITY NUMBER:
376701396
ADMINISTRATOR:ALEXANDRA POPFACILITY TYPE:
850
ADDRESS:6540 FLANDERS DRIVETELEPHONE:
(858) 550-0097
CITY:SAN DIEGOSTATE: CAZIP CODE:
92121
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 65DATE:
07/11/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Alexandra PopTIME COMPLETED:
10:00 AM
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On 7/11/23 Licensing Program Analyst (LPA) Annette Sutherland made an unannounced case management visit to follow up on a self reported incident that occurred on 6/28/23.
Upon arrival, LPA met with Director, Alexandra Pop. There were 65 children present with 13 staff members. The facility is within licensed capacity/ratio limitations.

On 6/28/23 , a 6 year old child (C1) was playing outside on the monkey bars, child fell on their arm . C1 landed on the cushioned artificial grass padding. Staff member #1(SM1) observed C1 fall and assisted C1 and assessed the child for injuries. SM1 called assistant director for assistance as child was complaining of pain. Director immediately notified the child's parents of incident. C1 was picked up immeidatly and taken to the Doctor where child was diagnosed with a broken arm, requiring a removable cast. Child returned to school the following week.

LPA observed the play structure to be in good repair and suitable for elementary children ages 6 years old . In addition, LPA observed a artificial padded turf underneath the monkey bars. During today's visit LPA conducted interviews with staff and obtained and reviewed documentation related to the incident. Based on the information gathered during today’s visit, supervision was in place, ratios were met, the facility responded appropriately and reported timely.  In addition, confidential names list was created.

No deficiencies issued during today’s inspection. An exit interview was conducted. A Notice of Site Visit (LIC 9213), along with this report was provided to the Director. LPA informed Director LIC9213 must be posted for 30 days from today’s date. LPA observed notice of site visit posted prior to exiting facility.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2023
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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