376700376-8-22-2023-51-CC-GCUS-CUXQY8-20230822123442

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376700376
Report Date: 08/22/2023
Date Signed: 08/22/2023 12:34:45 PM

Document Has Been Signed on 08/22/2023 12:34 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 SMS		FACILITY NUMBER:	376700376
ADMINISTRATOR:	LETISIA FORD		FACILITY TYPE:	850
ADDRESS:	453 LA MOREE ROAD		TELEPHONE:	(760) 750-8750
CITY:	SAN MARCOS	STATE: CA	ZIP CODE:	92078
CAPACITY:	176	CENSUS: 86	DATE:	08/22/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Letisia Ford		TIME COMPLETED:	12:40 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 August 22, 2023 at 10:30 a.m. Licensing Program Analyst, Leilani Curtis, conducted an unannounced inspection to follow up on self-reported incident that occurred on 08/17/2023. Upon arrival LPA met with Director Letisia Ford and proceeded to tour the facility. There were 86 children with 18 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), and staff #2 (S2). Facility staff state that on 08/17/23 at approximately 11:00 a.m., seven children with two staff members were having a “dance party” and/or music & movement session in the “soft room” when a 2-year-old daycare child (C1), who was jumping on the pillows started to cry. The staff members state that C1 did not fall down and was not bumped by other children. C1 had no visible injuries. Staff comforted C1. The assistant director assessed the child and notified C1’s parent of the situation. C1 was taken to the doctor and diagnosed with a dislocated left elbow. At the time of the incident there were 7 children with 2 staff members. 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. LPA toured the area where the incident occurred. LPA observed that the classroom is carpeted and contains several large pillow seats and a corner seating area constructed of soft vinyl and covered with pillows. The director states that she spoke with staff about limiting the type of activities completed in the room. The room will be used for reading and other quiet activities. Staff will continue to review the rules of the "soft room" with the children prior to it’s use. No deficiency cited.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace Curtis	TELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023

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: CENTER FOR CHILDREN & FAMILIES AT CAL STATE SMS	FACILITY NUMBER: 376700376
	VISIT DATE: 08/22/2023

NARRATIVE

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On LPA Curtis's Case Management Inspection dated 8/17/23 the director stated that she would submit an itemized plan documenting the steps staff must follow to ensure proper supervision. During today's inspection LPA obtained a copy of the supervision plan.

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 Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace Curtis	TELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023

LIC809 (FAS) - (06/04)

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