376600033-4-28-2023-51-CC-KLAE-CRBW46-20230428165701

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376600033
Report Date: 04/28/2023
Date Signed: 04/28/2023 04:57:11 PM

Document Has Been Signed on 04/28/2023 04:57 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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	SAY - KUMEYAAY EXTENDED DAY PROGRAM		FACILITY NUMBER:	376600033
ADMINISTRATOR:	THOMAS TEAGUE		FACILITY TYPE:	840
ADDRESS:	6474 ANTIGUA BOULEVARD		TELEPHONE:	(858) 688-2187
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92124
CAPACITY:	75	CENSUS: 42	DATE:	04/28/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:	Ashley Crump & Melanie Bautista		TIME COMPLETED:	05:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 4/28/23 at 2:10 PM, Licensing Program Analyst (LPA) Keturah Lane conducted an unannounced annual inspection at the facility. Upon arrival, LPA met with staff member Ashley Crump and toured the facility. During today’s visit were 29 school age children (and later more children arrived – 42 children at 2:45 PM) in the multi-purpose room with six staff members present: Thida Folta, Jalyn Ayala, Jasmine Rodriguez, Aurora Fraire, Ashley Crump and substitute Richard Farelli. Facility also has room #24 and library available but were not in use at time of inspection. All required notices, forms and license were posted. Senior Program Director Melanie Bautista arrived at approximately 2:30 PM to assist with the inspection. Appropriate care & visual supervision were observed during the visit. Children were observed engaging in curriculum and homework activities in the multipurpose room and physical/play activities in the outdoor area. Furniture and age appropriate equipment is in good condition. Care areas have adequate heating, lighting and ventilation. Bathrooms are across from the multipurpose room and maintained with operational toilets and faucets with appropriate temperature. Hand dryers and toilet paper are available in both restrooms. Bathroom is lighted and has ventilation. Snack menu is posted. Adequate food is available for snacks. Cleaning supplies are kept separate from food and are inaccessible to children. The outdoor play area consists of a blacktop and field area. Equipment structures are age appropriate and marked 5-12 years, have sufficient cushioning and securely fixed to the ground. Area has canopies and trees used for shade. There are no bodies of water at this facility. Children have access to facility water fountains and children also bring water bottles for drinking water. Storage containers solid waste have tight-fitting covers and are kept in good repair. Director stated there are no firearms or other weapons on the premises. All food/beverages capable of rapid spoiling are stored in covered containers at 45 degrees F or less. Facility appears to be free of insects and rodents. There is an operational carbon monoxide detector at the facility located on back file cabinet by back door (in multi-purpose room) that leads to play area outside. (continued on LIC809-C...)

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Keturah Lane	TELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023

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: SAY - KUMEYAAY EXTENDED DAY PROGRAM	FACILITY NUMBER: 376600033
	VISIT DATE: 04/28/2023

NARRATIVE

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Personnel records contain health screening documentation and at least one staff member has current CPR and First Aid certifications. All staff have completed mandated reporter training and required immunizations. Each personnel record contains documentation of eductional background and training. Sign ins were reviewed. Children’s records were reviewed and found to be in order. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm LPA and director discussed California Megan's Law and he provided director with the website address: www.meganslaw.ca.gov for her to review information regarding her facility on a regular basis.

No deficiencies are cited as the facility appeared to be in substantial compliance during today’s visit. Exit interview conducted and report was reviewed with Senior Program Director Melanie Bautista. Notice of site visit was provided and must remain posted for 30 days.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Keturah Lane	TELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023

LIC809 (FAS) - (06/04)

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