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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600967
Report Date: 05/12/2022
Date Signed: 05/12/2022 10:22:18 AM

Document Has Been Signed on 05/12/2022 10:22 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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:CHILDREN'S CHOICE - INFANTFACILITY NUMBER:
376600967
ADMINISTRATOR:FREDA SIMMONSFACILITY TYPE:
830
ADDRESS:1465 EAST MADISON AVENUETELEPHONE:
(619) 442-4014
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY: 19TOTAL ENROLLED CHILDREN: 19CENSUS: 12DATE:
05/12/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Teacher Candace CammonTIME COMPLETED:
10:30 AM
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On 5/3/2022, Licensing Program Analyst, Joelle Redding, made an unannounced visit to evaluate the circumstances surrounding a self-reported incident that occurred on 3/18/22, when a 17 mo. old child (Child #1) tumbled off the platform of a small play climber and sustained a bump to the head. Director was out ill, however, LPA was able to connect via telephone.

LPA reviewed the equipment and the area where the equipment was located at the time of the incident, spoke with the Director and reviewed a statement written by Staff #1 who was the staff present at the time. LPA reviewed the equipment online and determined that the play climber is made by Step2. Manufacturer's recommendation states that the equipment is to be used by children 18 months to 5 years. Child #1 was not yet 18 months at the time when the climber was used by the infant program.

Based on this information, a Type B citation will be cited on the accompanying LIC 809D for using play equipment beyond outside the range of manufacturer's recommendations.

Notice of Site Visit was given and will remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Joelle Redding
LICENSING EVALUATOR SIGNATURE: DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2022
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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Document Has Been Signed on 05/12/2022 10:22 AM - It Cannot Be Edited


Created By: Joelle Redding On 05/12/2022 at 08:15 AM
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: CHILDREN'S CHOICE - INFANT
FACILITY NUMBER: 376600967

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/12/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/26/2022
Section Cited
CCR
101438.2(d)

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Outdoor Activity Space for Infants. The outdoor activity space shall be equipped with a variety of age-appropriate toys and equipment.

This requirement was not met as evidenced by:
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Director immediately moved the climbler out of the infant play space and understands that the manufacturer information should be reviewed to ensure all play equipment is age appropriate for the age group using it.

No further correction is required.
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Based on observation, interview and review of relevant documentation, the facility was using a play climber that was not age appropriate for children under 18 months. Child #1 was 17 months at the time of the incident. This is a potential hazard to the health and safety of children in care.
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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:Renesha Pack
LICENSING EVALUATOR NAME:Joelle Redding
LICENSING EVALUATOR SIGNATURE:
DATE: 05/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2022


LIC809 (FAS) - (06/04)
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