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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700465
Report Date: 10/06/2021
Date Signed: 10/06/2021 11:26:18 AM

Document Has Been Signed on 10/06/2021 11:26 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:YALE PRESCHOOL - SYCAMOREFACILITY NUMBER:
376700465
ADMINISTRATOR:BARBARA GIDDENSFACILITY TYPE:
850
ADDRESS:10201 SETTLE ROADTELEPHONE:
(619) 956-5057
CITY:SANTEESTATE: CAZIP CODE:
92071
CAPACITY: 60TOTAL ENROLLED CHILDREN: 0CENSUS: 15DATE:
10/06/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Delia SalcIdoTIME COMPLETED:
11:30 AM
NARRATIVE
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On 10/6/2021 @ 10:20AM, Licensing Program Analyst (LPA) Nancy Diaz conducted an unannounced case management inspection. This is in reference to facility's self-reported incident that occurred on 8/19/2021 wherein a 3-year old child was left unsupervised in the play yard for approximately 3-5 minutes. This child was found in the play yard by parent during pick up.

LPA observed 15 preschool children present today with staff Dori Holm, Tyler Erwin and Kelli Morrissey.

A tour of the facility was conducted with Ms. SalcIdo. She stated that a substitute staff was supervising during outdoor play when one child had to use the bathroom. Staff failed to conduct the name to face check before transitioning from the play yard to the bathroom.

Type A violation if not corrected, will have a direct and immediate risk to the health, safety, or personal rights of children in care.

Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

An exit interview was conducted with Ms. Salcedo. Appeal rights were discussed and a written copy was provided today. A notice of site visit was observed posted, this notice shall remain posted for 30 days.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2021
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 10/06/2021 11:26 AM - It Cannot Be Edited


Created By: Nancy Diaz On 10/06/2021 at 10:58 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: YALE PRESCHOOL - SYCAMORE
FACILITY NUMBER: 376700465

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/06/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/06/2021
Section Cited
CCR
101229(a)(1)

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RESPONSIBILITY FOR PROVIDING CARE AND SUPERVISION. 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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CORRECTED. Ms. Salcedo stated that Hope Baker met with the substitute staff to discuss the importance of visual supervision. Ms. Hope also met with staff individually to discuss supervision of children at all times. A transition sheet was also created to ensure that staff conduct a name to face check before transitioning. Licensee also created a substitute checklist.
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Based on the documentation provided to the department and information provided by Ms. Salcedo. Licensee reported that a substitute staff failed to provide visual supervision when she transitioned her group to the bathroom, leaving a 3-year old child alone in the play area.
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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 Daniel
LICENSING EVALUATOR NAME:Nancy Diaz
LICENSING EVALUATOR SIGNATURE:
DATE: 10/06/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/06/2021


LIC809 (FAS) - (06/04)
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