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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700417
Report Date: 05/22/2023
Date Signed: 05/22/2023 03:40:53 PM


Document Has Been Signed on 05/22/2023 03:40 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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108



FACILITY NAME:SKYLINE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
376700417
ADMINISTRATOR:JACQUELINE SERRANOFACILITY TYPE:
830
ADDRESS:11330 CAMPO ROADTELEPHONE:
(619) 415-5485
CITY:LA MESASTATE: CAZIP CODE:
91941
CAPACITY:45CENSUS: 25DATE:
05/22/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Jacqui Serrano TIME COMPLETED:
03:55 PM
NARRATIVE
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On 5/22/2023, at 1:35 pm., Licensing Program Analyst (LPA) Vicky Williamson conducted an unannounced case management inspection to follow up regarding a self reported incident. LPA met with Director, Jacqui Serrano. LPA discussed the purpose of the inspection and was led on a tour of the facility. There are three (3) infant classes in operation. There were 25 infants with five (5) staff members.

Director stated that on 2/21/2023 at 10:30am there were three (3) staff and 10 children on the infant playground. Director stated that at 10:55am, Staff 1 (S1), Staff 2 (S2), Staff 3 (S3) and 10 children began transitioning from the playground to the inside of the building. Child (C1) was left behind on the playground for approximately 6 minutes without supervision. Director stated that C1 wandered into a play structure unnoticed by staff. The infant playground is located directly outside the door of the facility as well as two classrooms and Director and Assistant Director's offices.

Interviews were conducted with the director, assistant director, and staff. A review of video footage disclosed that C1 was on the playground with two teachers, one assistant and 10 children. The video footage showed three staff lining children up to transition inside the facility. C1 was observed going into a play structure prior to the transition period. An interview with S1 disclosed that staff present on the playground did not inspect the playground or play structures prior to leaving the area. At approximately 11:03 am, S4 observed C1 standing by the locked gate in the infant playground and returned C1 back to the classroom.

Director stated that a training regarding supervision of children was conducted on 2/27/2023. Director stated that she has implemented using the Brightwheel App name to face procedure at all times.

See LIC 809C continuation...

SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Vicky WilliamsonTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:
DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/22/2023
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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: SKYLINE CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 376700417
VISIT DATE: 05/22/2023
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Based on interviews and video footage, a Type A deficiency of California Code of Regulations, Title 22, Division 12, Chapter 1, is being cited on the attached LIC 809D.

LPA informed Director, Jacqui Serrano that this report dated 5/22/2023 documents one (1) Type A citation, which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care. Also, LPA informed Director, Jacqui Serrano to provide a copy of this licensing report dated 5/22/2023 that documents a 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. LPA provided Director, Jacqui Serrano with form LIC 9224.

An exit interview conducted with Director, Jacqui Serrano, a copy of this report along with the Appeals Rights (LIC 9058) was provided. A Notice of Site Visit is provided and required to be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. LPA observed Director post Notice of Site Visit on the bulletin board.

SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Vicky WilliamsonTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 05/22/2023 03:40 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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108


FACILITY NAME: SKYLINE CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 376700417

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/09/2023
Section Cited
CCR
101229(a)(1)

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101229(a) The licensee shall provide care and supervision... (1) No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation.
This requirement is not met as evidenced by:
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Director stated that she has retrained staff on supervision. Director stated that will view the video Supervising Children in Child Care Centers on CCLD webstie and submit a staff sign in sheet, summary of the video, and a written plan of correction to the SDRO by 6/9/23.
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Based on interview and record review, the licensee did not ensure that Child 1 (C1) was provided visual supervision at all times, which poses an immediate Health, Safety and Personal Rights risk to persons 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: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Vicky WilliamsonTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:
DATE: 05/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/22/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3