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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628114
Report Date: 06/07/2022
Date Signed: 06/14/2022 08:22:17 AM

Document Has Been Signed on 06/14/2022 08:22 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:HALL, LAURYN FAMILY CHILD CAREFACILITY NUMBER:
376628114
ADMINISTRATOR:LAURYN HALLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 229-9624
CITY:SAN DIEGOSTATE: CAZIP CODE:
92109
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
06/07/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Lauryn HallTIME COMPLETED:
05:00 PM
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THIS IS AN AMENDED REPORT PROVIDED ON 6/14/22.

On 6/14/22 at 8:15 AM Licensing Program Analyst, Adrian Mangina, made an unannounced visit to follow up on a self-reported incident that occurred on 6/6/22 where in a child year fell off a picnic table and sustained an injury.

LPA was unable to interview Staff #1 who was nearest Child #1 as the staff had already left the facility. LPA conducted interviews of staff and determined that at the time of the incident, there were 10 children present in the backyard, with one assistant supervising and Licensee watching as lunch was prepared in the kitchen which overlooks the yard. Staff #1 was positioned in the center of the yard, sitting on a ledge attached to the shed, with a full view of the yard to properly supervise children when the child fell off a picnic table. Staff attended to the child immediately, after which the child's parents were called During the inspection, LPA concluded proper supervision was in place, ratios were met, picnic table was being used as manufacturer suggested, cushioning on ground was sufficient, the facility responded appropriately and reported timely.

No deficiencies are cited.

Exit interview conducted and report was reviewed with the licensee, Lauryn Hall. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/14/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: HALL, LAURYN FAMILY CHILD CARE
FACILITY NUMBER: 376628114
VISIT DATE: 06/07/2022
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SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
LIC809 (FAS) - (06/04)
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