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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370800939
Report Date: 11/09/2023
Date Signed: 11/09/2023 04:15:31 PM

Document Has Been Signed on 11/09/2023 04:15 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:CHARLEY BROWN CHILDREN'S CENTERFACILITY NUMBER:
370800939
ADMINISTRATOR:ELIZABETH CORTESEFACILITY TYPE:
850
ADDRESS:5921 JACKSON DRIVETELEPHONE:
(619) 463-5126
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY: 94TOTAL ENROLLED CHILDREN: 87CENSUS: 66DATE:
11/09/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Cassidie JustoTIME COMPLETED:
04:45 PM
NARRATIVE
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On 11/9/2023, at 1:30pm, Licensing Program Analyst (LPA) Vicky Williamson conducted an unannounced case management inspection regarding a self - reported incident. LPA met with Assistant Director, Cassidie Justo. LPA discussed the purpose of the inspection and was led on a tour of the facility. There were 53 napping children with five (5) staff, eight (8) of the napping children are 18 -36 months.

On 9/18/2023, the director self- reported an incident involving Child #1 (C1) [See Confidential Names]. Per Director, the incident occurred on 9/14/2023 at approximately 10:00am.

Director reported that C1 was on the playground climbing on the net area of the climbing wall play structure when she lost her footing causing her to lean backwards landing on both of her hands. C1 sustained an injury requiring medical attention.

Interviews were conducted with the the Assistant Director, Staff #1 (S1) [See Confidential Names] and C1's Authorized Representative. S1 stated that she was supervising C1 while she was playing on the play structure, however she was unable to break the fall. Assistant Director stated that ice was immediately applied to the injury and C1's authorized representative was contacted immediately. S1 stated that she and Staff #2 (S2) [See Confidential Names] were supervising 12 children on the playground during the time of the incident.

LPA was unable to observe the climbing wall play structure. Assistant Director stated that the play structure was removed from the playground. On 9/18/2023, Director, Elizabeth Cortese provided a photo of the play structure along with the incident report. During the inspection, LPA was provided a copy of the manufacturer's manual and it was determined that the climbing wall play structure is not age appropriate for a three year old. The play structure is designed for children ages ages 4 - 8 years of age.

See LIC 809C Continuation...

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: CHARLEY BROWN CHILDREN'S CENTER
FACILITY NUMBER: 370800939
VISIT DATE: 11/09/2023
NARRATIVE
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Based on interviews and manufacturer's manual, one (1) Type A deficiency of California Code of Regulations, Title 22, Division 12, Chapter 1, is being cited on the attached LIC 809D.

An exit interview was conducted with Assistant Director, Cassidie Justo, and a copy of this report, Appeal Rights and Confidential Names (LIC 811) were provided to Assistant Director. 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. LPA observed Notice of Site Visit posted on the bulletin board at the entrance.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/09/2023 04:15 PM - It Cannot Be Edited


Created By: Vicky Williamson On 11/09/2023 at 03:37 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: CHARLEY BROWN CHILDREN'S CENTER
FACILITY NUMBER: 370800939

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/09/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/15/2023
Section Cited
CCR
101223(a)(2)

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Personal Rights (a)The licensee shall ensure that each child is accorded the following personal rights:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by:

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Asst. Director stated that the play structure was removed. Asst. Director stated that staff will review personal rights regulation and view the video Children's Personal Rights in Child Care on the CCLD website and submit a summary of the video,staff sign in sheet and also a written plan of correction to the
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Based on interview and record review, the licensee did not comply with the section cited above in 1 out of 87 persons, as C1 was not accorded safe equipment due to the wall play structure was not age appropriate for a 3 year old, which poses an immediate health, safety, or personal rights risk to persons in care.
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SDRO, no later than 11/15/2023

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Tulam Vu
LICENSING EVALUATOR NAME:Vicky Williamson
LICENSING EVALUATOR SIGNATURE:
DATE: 11/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/09/2023


LIC809 (FAS) - (06/04)
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