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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600851
Report Date: 11/01/2022
Date Signed: 11/01/2022 05:29:34 PM


Document Has Been Signed on 11/01/2022 05:29 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- MARVIN EXTENDED DAY PROGRAMFACILITY NUMBER:
376600851
ADMINISTRATOR:SARANN SOKFACILITY TYPE:
840
ADDRESS:5720 BRUNSWICK AVENUETELEPHONE:
(858) 212-4703
CITY:SAN DIEGOSTATE: CAZIP CODE:
92120
CAPACITY:112CENSUS: 65DATE:
11/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Sarann SokTIME COMPLETED:
05:30 PM
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Licensing Program Analyst (LPA) Tyra Block conducted an unannounced annual inspection. LPA met with facility representative, Sarann Sok. The indoor and outdoor of the facility was inspected. The following ratios were observed during the inspection: 3 staff with 65 children, 1 additional staff arrived at 2:54pm and another at 3:43pm. Other children arrived from extracurricular activities during the visit. The facility was not operating within licensed capacity and ratio limitations. Children were observed to be under visual supervision in the auditorium/ cafeteria. The classroom and restrooms have adequate lighting, heating, and ventilation. All floors appeared to be safe and clean. Furniture and children's cubbies appeared to be in good condition. There were activities and supplies available for children to use. Trash cans have tight-fitting cover and disinfectants, cleaning solutions and other hazardous items are stored so they are inaccessible to children. Medication policies and procedures were reviewed. Menu for snacks is posted monthly. All food inspected was protected from contamination, the snack preparation area appeared to be clean and no signs of pests were observed. Sign in/out sheets were reviewed showing signature and time of day recorded. The surface of the outdoor activity space is maintained in a safe condition with sufficient shade. Drinking water is available inside the classroom and outdoor play area for children to refill their water bottles. A fire extinguisher rated 2A10BC an CO detector were observed. Fire inspection conducted 10/20/22.

There are no bodies of water or weapons present on the premises. Disaster drills are conducted monthly and last drill was documented on 9/23/22. Backstage is designated for use by children who are ill. A sample of children records, including medical assessment, identification and emergency information were reviewed. Staff's records and transcripts were reviewed to verify teacher qualifications and experience. Opening and closing staff members have current CPR and First Aid certifications. A review of staff records indicate that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Tyra BlockTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2022
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: SAY- MARVIN EXTENDED DAY PROGRAM
FACILITY NUMBER: 376600851
VISIT DATE: 11/01/2022
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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 Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.
Community Care Licensing WEB SITE: http://www.ccld.ca.gov

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.

LPA discussed that prior to any structural changes such as an increase or decrease to indoor or outdoor activity space or room additions, the Department shall be notified.

A type B deficiency was cited on LIC 809-D during today's visit inspection for operating out of ratio. An exit interview was conducted and the report was reviewed with the facility representative, Sarann Sok.

A Notice of Site Visit was given and must be posted for 30 days.

SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Tyra BlockTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 11/01/2022 05:29 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: SAY- MARVIN EXTENDED DAY PROGRAM
FACILITY NUMBER: 376600851

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101516.5(b)
Teacher-Child Ratio
(b) There shall be a staffing ratio of one teacher and one aide present to every 28 children in attendance.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above there were 65 children present with only 3 staff which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/07/2022
Plan of Correction
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Director stated she will provide a written plan detailing plan to maintain compliance in the future including informing agency so additional staff can be provided timely when staff calls out. Written plan will be provided by POC due date of 11/7/22.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Tyra BlockTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2022
LIC809 (FAS) - (06/04)
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