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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700376
Report Date: 08/17/2023
Date Signed: 08/17/2023 03:36:07 PM


Document Has Been Signed on 08/17/2023 03:36 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:CENTER FOR CHILDREN & FAMILIES AT CAL STATE SMSFACILITY NUMBER:
376700376
ADMINISTRATOR:LETISIA FORDFACILITY TYPE:
850
ADDRESS:453 LA MOREE ROADTELEPHONE:
(760) 750-8750
CITY:SAN MARCOSSTATE: CAZIP CODE:
92078
CAPACITY:176CENSUS: 80DATE:
08/17/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Letisia FordTIME COMPLETED:
03:50 PM
NARRATIVE
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On August 17, 2023 at 1:00 p.m. Licensing Program Analyst, Leilani Curtis, conducted an unannounced inspection to follow up on a self-reported incident that occurred on 08/10/2023. Upon arrival LPA met with Director Letisia Ford and proceeded to tour the facility. There were 80 napping children with 9 staff members present. Appropriate ratio/capacity was observed. Staff members have the required background clearances and are associated to the facility. LPA interviewed the director, staff #1 (S1), staff #2 (S2) and staff #3 (S3).

Facility staff state that on 08/10/23 at approximately 10:00 a.m. a 3-year-old daycare child (C1) was left unattended on the playground. After outside playtime, S1 and S2 transitioned their class from the playground into the classroom. Once the classroom door was closed and the children were inside of the classroom, S1 noticed that one child, C1, was not in the classroom. S1 went back outside to the playground and found C1 hiding behind a tree. Staff members state that C1 was left unsupervised on the playground for approximately one minute. Staff state that C1 was not in distress and was not injured. At the time of the incident there were 10 children with two staff members present. Proper ratio was in place at the time of the incident. The parent of C1 was notified of the incident the same day and Community Care Licensing was notified timely. The director states that the two staff members involved were interviewed, proper supervision was discussed, and the Child Supervision Record was reviewed.

See LIC809D for cited deficiency. This is a repeat violation. A civil penalty has been assessed.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:
DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/17/2023
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 3


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: CENTER FOR CHILDREN & FAMILIES AT CAL STATE SMS
FACILITY NUMBER: 376700376
VISIT DATE: 08/17/2023
NARRATIVE
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LPA Curtis informed Director Ford that this report dated 8/17/23 documents one Type A citation. Type A citations shall be posted for 30 consecutive days as there is/are immediate risks to the health, safety, or personal rights of children in care. Also, LPA Curtis informed Director Ford to provide a copy of this licensing report dated 8/17/23 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

An exit interview was conducted with Director Ford and Appeal Rights (LIC 9058) were discussed. The director’s signature on this form acknowledges receipt of these rights. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA observed the director post notice of site visit.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 08/17/2023 03:36 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: CENTER FOR CHILDREN & FAMILIES AT CAL STATE SMS
FACILITY NUMBER: 376700376

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/24/2023
Section Cited
CCR
101229(a)(1)

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Providing Care and Supervision: (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement was not met as evidenced by:
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The director states that she will submit an itemized plan documenting the steps staff must follow to ensure proper supervision. The director will send LPA a copy of the plan via email by 8/24/23.
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Based on interviews conducted by LPA, on 8/10/23 a daycare child (C1) was left unsupervised/unattended on the playground. This poses an immediate health, safety and/or personal rights risk to the 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: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:
DATE: 08/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/17/2023
LIC809 (FAS) - (06/04)
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