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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370805905
Report Date: 04/16/2026
Date Signed: 04/16/2026 03:57:34 PM

Document Has Been Signed on 04/16/2026 03:57 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
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:CHRISTIAN CREATIVE LEARNING ACADEMY/SCHOOL-AGEFACILITY NUMBER:
370805905
ADMINISTRATOR/
DIRECTOR:		PRISCILLA LAGUNAFACILITY TYPE:
840
ADDRESS:2920 MAIN STREETTELEPHONE:
(619) 698-4306
CITY:LEMON GROVESTATE: CAZIP CODE:
91945
CAPACITY: 40TOTAL ENROLLED CHILDREN: 18CENSUS: 5DATE:
04/16/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:50 PM
MET WITH:Priscilla LagunaTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
NARRATIVE
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On April 16, 2026, at 2:50 pm., Licensing Program Analyst (LPA) Angela Nguyen conducted an unannounced case management inspection to follow up on a self reported incident reported on April 2, 2026. LPA met with Facility Representative, Priscilla Laguna. LPA discussed the purpose of the inspection and was led on a tour of the facility. There were five children being supervised by with two staff member.

Interviews were conducted with the Facility Representative, one staff member and one day care child.

Facility Representative stated that Staff #1 (S1) contacted her by phone to notify her that Child #1 (C1) fell and was bleeding at a nearby park. Facility Representative stated that she immediately drove to the park to pick up C1 to return to the facility to contact C1's parent. At arrival, Facility Representative stated that she observed C1 with a paper towel on his head to stop the bleeding. Facility Representative stated that there was two staff members supervising seven children. Facility Representative stated that C1 was taken to seek medical attention that day and returned to school the following day.

Staff interviews stated they observed C1 slipped and fell and hit his head on the rain gutter while playing hide and seek. Staff stated that there were seven children (no names disclosed) present at the park. Staff stated that there were no children were around C1 when the incident occurred. Staff stated that S1 immediately ran over to C1 as she saw him roll onto the grass from the metal rain gutter to see blood coming from his head. Staff stated that she contacted Director, Priscilla Laguna shortly after and was picked up and returned to the facility by Laguna.


***See continuation on LIC 809D***
NAME OF LICENSING PROGRAM MANAGER: Tulam Vu
NAME OF LICENSING PROGRAM ANALYST: Angela Nguyen
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/16/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: CHRISTIAN CREATIVE LEARNING ACADEMY/SCHOOL-AGE
FACILITY NUMBER: 370805905
VISIT DATE: 04/16/2026
NARRATIVE
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C1 stated that about 2 weeks ago he was playing hide and seek at the park when he squatting down while running and slipped on a metal sewage drain, hitting the right side of his head. C1 stated that there was four other friend and one adult at the park with him. C1 stated that S1 ran over to him when she heard him crying. C1 stated that no one saw him fall because they were hiding from him. C1 stated that he received three staples in his head from the injury. C1 stated that he came back to school the next day.

Children interviews stated that they were playing hide and seek at the park and heard C1 crying and went over to see what happened. Children interviews stated that S1 immediately ran over to C1 and administered first aid until the Director came to pick up C1. Children interviews confirmed that they were not close to C1 and saw him slip in the grass before falling.

Based on the information obtained during the incident investigation, this incident appears to be an accident. This concludes the incident investigation.

Notice of site visit was given and must be posted for 30 days. Exit interview was conducted and this report was reviewed with the Facility Representative, Priscilla Laguna.
NAME OF LICENSING PROGRAM MANAGER: Tulam Vu
NAME OF LICENSING PROGRAM ANALYST: Angela Nguyen
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2026
LIC809 (FAS) - (06/04)
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