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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700416
Report Date: 11/22/2024
Date Signed: 11/22/2024 04:17:35 PM

Document Has Been Signed on 11/22/2024 04:17 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:SKYLINE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
376700416
ADMINISTRATOR/
DIRECTOR:
JACQUELINE SERRANOFACILITY TYPE:
850
ADDRESS:11330 CAMPO ROADTELEPHONE:
(619) 415-5485
CITY:LA MESASTATE: CAZIP CODE:
91941
CAPACITY: 72TOTAL ENROLLED CHILDREN: 68CENSUS: 30DATE:
11/22/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Jacqueline SerranoTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On 11/22/2024 at 02:00 PM Licensing Program Analyst (LPA), Dana Stevens conducted an unannounced Case Management inspection. The purpose of this inspection is to follow up on an Unusual Incident. Upon arrival, LPA met with Director Jacqueline Serrano. There were 30 children present with 8 staff members.

The department received an Unusual Incident Report submitted by Director on 10/28/2024. On 10/25/2024, around 3:55 PM, Child 1 (C1) was playing with a car on the lower preschool playground and tripped, falling upon his left arm. C1 was taken to the Director's office where ice was applied to C1's arm and C1's parent was called, informing them of the incident. C1 was picked up within 30 minutes by an authorized representative. Director was informed later the same day that C1 received medical treatment for the injury.


Interviews were conducted with Director and staff members and LPA inspected lower preschool playground.

LPA found the lower preschool playground to be safe and free of hazards. Facility staff took appropriate action in applying first aid and notifying C1's parents of the incident immediately. The incident was reported timely to Licensing via an Unusual Incident Report (LIC 624.)

No violations found, no deficiencies cited.

An exit interview was conducted with Director, Jacqueline Serrano. Notice of Site Visit shall be posted for 30 days.
SUPERVISORS NAME: Cynthia Biszant
LICENSING EVALUATOR NAME: Dana Stevens
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2024
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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