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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372006470
Report Date: 05/15/2023
Date Signed: 05/15/2023 03:26:58 PM


Document Has Been Signed on 05/15/2023 03:26 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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108



FACILITY NAME:KLASSIC KIDS DAY CARE - HAGE ELEMENTARYFACILITY NUMBER:
372006470
ADMINISTRATOR:PATRICIA PEREZFACILITY TYPE:
840
ADDRESS:9750 GALVIN AVENUETELEPHONE:
(858) 265-9552
CITY:SAN DIEGOSTATE: CAZIP CODE:
92126
CAPACITY:75CENSUS: 45DATE:
05/15/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:13 PM
MET WITH:Red ComilangTIME COMPLETED:
03:45 PM
NARRATIVE
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On 5/15/2023 @ 2:13PM, Licensing Program Analyst (LPA) Nancy Diaz conducted an unannounced case management inspection in reference to a self-reported incident that occurred in February 2023. LPA met with Red Comilang, Acting Site Supervisor. LPA also interviewed a staff who witnessed this incident.

It was alleged that site director Patricia Perez inappropriately restrained a child in care sometime in February 2023. Ms. Perez grabbed both of child's arms and used her leg to sweep child's legs bringing both of them to the ground in a seated position.

Staff who witnessed this incident stated that the child involved did not appear to be hurt or injured.

It was noted that this incident was not reported to the department in a timely manner.

TYPE B DEFICIENCIES WERE CITED.

Exit interview was conducted with Mr. Comilang. A copy of this report and appeal rights were provided. Notice of site visit was provided and observed posted. This notice shall remain posted for 30 days.

SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 05/15/2023 03:26 PM - It Cannot Be Edited

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: KLASSIC KIDS DAY CARE - HAGE ELEMENTARY
FACILITY NUMBER: 372006470

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/22/2023
Section Cited
CCR
101223(a)(3)

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PERSONAL RIGHTS.
To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule,...

This requirement was not met as evidenced by:
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Mr. Comilang stated that the organization conducted their investigation that resulted to the Site supervisor's dismissal from the agency. Copy of documentation shall be submitted to the department no later than 5/22/2023.
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Based on interview, Staff observed the site supervisor grabbed a child by both arms, and used her legs to sweep child's legs. Both staff and child fell to the floor as the result of staff's action.
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Type B
05/22/2023
Section Cited
CCR101212(d)(1)(C)

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REPORTING REQUIREMENTS. Upon the occurrence, during the operation of the child care center of any of the events specified...(C) Any unusual incident...
This requirement was not met as evidenced by:
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We will review with the staff the "staff handbook" and highlight the area for unusual incidents reporting. Documentations of this review will be submitted to the department no later than 5/22/2023.
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Based on interview, facility failed to report the unusual incident that happened in February 2023 involving a staff who inappropriately restrained a child.
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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: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2