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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700376
Report Date: 03/09/2022
Date Signed: 03/09/2022 11:03:34 AM


Document Has Been Signed on 03/09/2022 11:03 AM - 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: 86DATE:
03/09/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Letisia FordTIME COMPLETED:
11:15 AM
NARRATIVE
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On March 9, 2022 at 8:30 a.m. Licensing Program Analyst, Leilani Curtis, conducted an unannounced inspection to follow up on a self-reported incident that occurred on 3/2/22, wherein a 3-year-old child (C1) was left unattended in a restroom. LPA met with Director Letisia Ford and proceeded to tour the facility. There were 86 children with 15 staff members present. Appropriate ratio/capacity were observed. Staff members have the required background clearances and are associated to the facility.

LPA interviewed staff #1, staff #2 and the director. On 3/2/22 there were 35 children with 6 staff members outside on the playground. At approximately 10:50 a.m. staff #1 was supervising a group of 4 children from the playground in the restroom located between classrooms #129 and #133. Proper ratios were in place. After staff #1 returned to the playground with the children she was supervising, staff #2 noticed that C1 was missing. Staff #2 returned to the restroom, opened the door and found C1 alone in the restroom unharmed. C1 was left unattended in the restroom for approximately 10 minutes. Staff #2 brought the child back to the group and the parent of C1 was notified of the incident the same day. The director states that she discussed the incident and proper supervision with the staff members involved and retrained staff #1 on supervision and transitions. The director states that she we conduct further training on supervision and transitions with all staff members.

See LIC809D for cited deficiency.

An exit interview was conducted with the director and appeal rights (LIC 9058 1/16) 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: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2022
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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Document Has Been Signed on 03/09/2022 11:03 AM - 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: 03/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/25/2022
Section Cited

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101229(a)(1) Responsibility for 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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Based on interviews with staff #1, staff #2 and the director, child #1 (C1) was left unattended in a restroom for approximately 10 minutes on 3/2/22. This poses a potential health and 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: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:
DATE: 03/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2022
LIC809 (FAS) - (06/04)
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