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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700166
Report Date: 01/28/2020
Date Signed: 01/28/2020 06:05:59 PM

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:EAST COUNTY FAMILY YMCA - DAILARDFACILITY NUMBER:
376700166
ADMINISTRATOR:GABRIELA GUTIERREZFACILITY TYPE:
840
ADDRESS:6425 CIBOLA ROADTELEPHONE:
(619) 789-9970
CITY:SAN DIEGOSTATE: CAZIP CODE:
92120
CAPACITY:160CENSUS: 127DATE:
01/28/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Gabriela GutierrezTIME COMPLETED:
06:15 PM
NARRATIVE
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Licensing Program Analysts (LPAs), Tyra Block and Selina Siao, conducted an unannounced case management visit today. The purpose of the visit was to follow-up on an incident that was self-reported to the department on 12/19/19. LPAs met with Ms. Gabi (Gabriela Gutierrez, Site Supervisor) and toured the facility. Present today were 127 children with 11 staff. The following areas are being utilized: Library, Multi-Purpose Room, YMCA Resource Room, and Play Ground.

On 12/18/19, a child in care was given a cookie containing tree nuts which caused an allergic reaction. The cookies were given as a gift to the staff but were used in a cooking activity for the children during clubs and given as a reward after helping to clean-up. Shortly after eating the cookie the child began to show symptoms of an allergic reaction and notified the staff. Staff was able to identify that the cookies contained tree nuts, a known allergen for the child. The prescribed Epi-pen was administered and 9-1-1 called. The child received follow-up medical treatment and returned to care the next day.

LPAs interviewed several staff who were present the day of the incident and observed child's file and stored medication.

Based on observation and interviews a Type A citation was issued. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. This report and Notice of Site Visit must be posted for 30 days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent.

See LIC 809D for deficiencies cited during today's inspection. Director was provided a copy of the appeal rights form LIC 9058 and the signature on this form acknowledges receipt of these rights. Notice of Site Visit was posted during this visit and must remain posted for 30 days.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Tyra BlockTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020
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: EAST COUNTY FAMILY YMCA - DAILARD
FACILITY NUMBER: 376700166
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/28/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/29/2020
Section Cited

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Personal Rights 101223(a)(2):
(a)The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful...accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by:
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Based on observation and interviews, on 12/18/19 staff did not ensure the child was accorded safe and healthful accommodations due to staff giving child a cookie containing nuts that was provided by a source outside the facility which caused child to have an allergic reaction. This poses an immediate health and safety risk to the child and other children in care.
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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: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Tyra BlockTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:
DATE: 01/28/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/28/2020
LIC809 (FAS) - (06/04)
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