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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700166
Report Date: 10/16/2019
Date Signed: 10/16/2019 03:54:32 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:JENNIFER CONRADFACILITY TYPE:
840
ADDRESS:6425 CIBOLA ROADTELEPHONE:
(619) 789-9970
CITY:SAN DIEGOSTATE: CAZIP CODE:
92120
CAPACITY:160CENSUS: 132DATE:
10/16/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Samantha Garcia, Site SupervisorTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) D. Sanchez, made an unannounced Case Management inspection to the facility today in response to the Unusual Incident/Injury Report (UIR) occurred on 9/20/2019. Report states that staff observed child walking out of the Multi Purpose Room (MPR) and no staff appeared to noticed that child had left the room.

LPA interviewed facility staff, children and inspected the area where the incident occurred. Based on LPA's observation, review of the report and staff interviews, facility staff failed to provide visual supervision to child.

An exit interview was conducted with Samantha Garcia (Smith) and a copy of this report and LIC-809D left at the facility as well as appeal rights. During the course of this evaluation, LPA advised Samantha that all request for extensions of any citations/Proof of Corrections (POCs) must be made within 10 days to the issuing LPA on or before the date the POC is due. Appeals to citations must be made within 15 days in writing to the issuing LPA's supervisor on or before the date the POC is due.

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.

NOTICE OF SITE VISIT MUST BE POSTED FOR 30 DAYS
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Diana SanchezTELEPHONE: (619) 767- 2210
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2019
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: 10/16/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/18/2019
Section Cited

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Care and Supervision - No children shall be left without the supervision, including visual observation of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1). Based on observation, interview and report review.
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This requirement was not met as evidenced by: staff in charge was not aware of missing child until child was brought back into the class. This poses an immediate Health, Safety risk to 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: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Diana SanchezTELEPHONE: (619) 767- 2210
LICENSING EVALUATOR SIGNATURE:
DATE: 10/16/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2019
LIC809 (FAS) - (06/04)
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