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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700376
Report Date: 12/22/2022
Date Signed: 12/22/2022 10:28:43 AM


Document Has Been Signed on 12/22/2022 10:28 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: 0DATE:
12/22/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Letisia FordTIME COMPLETED:
10:30 AM
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On December 22, 2022 @ 9:30AM, Licensing Program Manager (LPM) Tashima Daniel, Licensing Program Analyst (LPA) Leilani Curtis, Director Letisia Ford and Kindercare District Leader Amanda Edwards-Seiler met virtually via Zoom for a scheduled office meeting. The purpose of the meeting is to discuss the recent facility citations.

The facility has been cited for the following deficiencies:
11/07/22:
101229(a)(1)- Responsibility for Providing Care and Supervision -child left alone in classroom & classroom bathroom.
101212(d)(1)(C)- Reporting Requirements -facility did not report timely that the child was left alone in the classroom/classroom bathroom.
05/25/22:
101223(a)(3)- Personal Rights -staff spoke to children inappropriately.
101216(e)(3)- Personnel Requirements -staff training was not provided.
04/07/22:
101229(a)(1)- Responsibility for Providing Care and Supervision -child left alone in a classroom.
03/09/22:
101229(a)(1)- Responsibility for Providing Care and Supervision -child left alone in a restroom.
09/08/21:
101220(b)(2)- Child’s Records -facility did not have a tuberculosis clearance for two of the ten children's files reviewed.
101229.1(b)- Sign In and Sign Out- 19 children did not have parent/guardian signatures signing them in on the sign in sheet.
06/13/19:
101229(a)(1)- Responsibility for Providing Care and Supervision -child left on the playground unattended.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:
DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/22/2022
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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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: 12/22/2022
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The citations were discussed and the Technical Support Program (TSP) was offered today. For questions related to TSP, email: Childcaretechnicalsupport@dss.ca.gov. The director advised the department of current procedures and policies they have put into place to ensure the health and safety of the children in care.

Director Ford agrees to operate the facility in full compliance with Title 22 and Health and Safety Code requirements.

The director was advised to regularly visit the Community Care Licensing WEB SITE: www.ccld.ca.gov for quarterly updates, Provider Information Notices (PIN’s) and Title 22 regulations. LPA will email the director the TSP handout. Due to a technical issue with Zoom this report was read to the director and Amanda Edwards-Seiler over the telephone.

A copy of this report and appeal rights were emailed to Director Ford at the conclusion of the meeting. The director will confirm receipt of this report via e-mail and the reply of confirmation will serve as the signature acknowledging these rights.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2