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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370800634
Report Date: 03/06/2024
Date Signed: 03/06/2024 02:15:52 PM

Document Has Been Signed on 03/06/2024 02:15 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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:LA MESA UNITED METHODIST CHILDREN'S CENTERFACILITY NUMBER:
370800634
ADMINISTRATOR:AMY FAGANFACILITY TYPE:
850
ADDRESS:4690 PALM AVENUETELEPHONE:
(619) 466-8407
CITY:LA MESASTATE: CAZIP CODE:
91941
CAPACITY: 87TOTAL ENROLLED CHILDREN: 82CENSUS: 50DATE:
03/06/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:31 AM
MET WITH:Nancy BetancourtTIME COMPLETED:
02:15 PM
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On 3/6/2024, at 11:31am., Licensing Program Analysts (LPAs) Vicky Williamson and Angela Nguyen conducted an unannounced case management inspection to follow up on a self reported incident. LPA met with Assistant Director, Nancy Betancourt. LPAs discussed the purpose of the inspection and was led on a tour of the facility. There were 50 children present with 10 staff members.

On 2/27/2024, the director self- reported an incident regarding Child 1 (C1) sustaining an injury requiring medical attention. Per Director, the alleged incident occurred on 2/26/2024 at about 10:20am.

During today’s inspection, LPA conducted interviews with assistant director and staff. LPA was unable to interview C1. LPA reviewed and obtained pertinent information.

No deficiencies cited during today’s inspection. An exit interview was conducted with Assistant Director, Nancy Betancourt and a copy of this report, Appeal Rights and Notice of Site Visit were provided. Notice of Site Visit is required to be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2024
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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