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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700376
Report Date: 11/07/2022
Date Signed: 11/07/2022 03:26:48 PM


Document Has Been Signed on 11/07/2022 03:26 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: 100DATE:
11/07/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:07 AM
MET WITH:Hannah Stehling, Assistant DirectorTIME COMPLETED:
03:40 PM
NARRATIVE
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On November 7, 2022 at 10:07 a.m. Licensing Program Analyst, Leilani Curtis, conducted an unannounced inspection to follow up on two self-reported incidents. The first incident occurred on 9/14/22 and the second incident occurred on 10/31/22. LPA met with Assistant Director Hannah Stehling and proceeded to tour the facility. There were 100 children with 17 staff members present. Appropriate ratio/capacity was observed. Staff members have the required background clearances and are associated to the facility. LPA interviewed the assistant director, staff #1 (S1), staff #2 (S2), staff #3 (S3), staff #4 (S4), staff #5 (S5), staff #6 (S6), child #1 (C1), child #2 (C2) and child #3 (C3).

Facility staff state that on 9/14/22 a 5-year-old daycare child (C1) was left unattended in a classroom bathroom. Staff members do not know how long C1 was left unsupervised in the classroom bathroom/classroom, but they state that he was probably alone for a very brief amount of time. During afternoon outside play time, between 4:00 p.m.-5:00 p.m. , S1 was on the playground when she noticed S2 walking away from the classroom. A few moments later she observed C1 open the classroom door and exit the classroom by himself to join the class which was outside on the playground. Proper ratios were in place at the time of the incident. The assistant director states that she was not aware of the incident until it was reported to Director Ford on 10/10/22. The parent of C1 was notified of the incident on 10/10/22. The assistant director states that each staff member in this "teaching pod" was spoken to individually about the incident. All staff members facility wide received an email regarding Title 22 regulations, bathroom supervision and Child Supervision Records. Ms. Stehling states that the facility "program specialists" are now supporting more in the classrooms and on the playground. In addition each class will have a formal observation done conducted by administration staff to ensure that adequate supervision is being provided. A report of this incident was not received by Community Care Licensing within the Departments next working day following the date of the incident, nor was a written report received with seven days following the incident. The department received written notification of the incident on 10/11/22.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:
DATE: 11/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2022
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 4


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: 11/07/2022
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On 10/31/22 at approximately 9:40 a.m. a child (C2) was running on the playground when she tripped and fell onto the ground. Another child (C3) fell over C2 and landed on the ground, injuring her right shoulder. Facility staff assessed C3 and applied ice to her shoulder. C2 was not injured. At the time of this incident proper ratios and supervision were in place. The parent of C3 arrived at the facility at approximately 9:45 a.m. for a previously scheduled, unrelated event and was notified of the incident. C3 was taken to the doctor later that day where she was diagnosed with a fracture to her right collarbone.

LPA inspected the playground where the incident occurred. LPA observed the area to be free from hazards. The area where the fall/injury occurred is covered with rubber surfacing material that absorbs the impact of a fall. The staff members responded to the injury appropriately and reported this incident timely.

See LIC809D for cited deficiencies. A civil penalty has been assessed.

LPA Curtis informed assistant director Hannah Stehling that this report dated 11/7/22 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 Assistant Director Stehling to provide a copy of this licensing report dated 11/7/22 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 Assistant Director Stehling and Appeal Rights (LIC 9058) were discussed. Ms. Stehlings 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 Assistant Director Stehling 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: 11/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 11/07/2022 03:26 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: 11/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/18/2022
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 conducted by LPA, on 9/14/22 a daycare child (C1) was left unsupervised/unattended in a classroom bathroom/classroom. This poses an immediate health and safety 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: 11/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4


Document Has Been Signed on 11/07/2022 03:26 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: 11/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/18/2022
Section Cited

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101212 Reporting Requirements: (d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. (C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child. This requirement was not met as evidenced by:
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Based on interviews and a record review, written notification of the 9/14/22 incident where a child was left unsupervised was not submitted to the department until 10/11/22. This poses a potential health and safety 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: 11/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4