<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701007
Report Date: 12/09/2019
Date Signed: 12/09/2019 03:30:22 PM

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:YMCA BARNARD ELEMENTARY PROGRAMFACILITY NUMBER:
376701007
ADMINISTRATOR:MARISA HENSONFACILITY TYPE:
840
ADDRESS:2445 FOGG STREETTELEPHONE:
(619) 672-6932
CITY:SAN DIEGOSTATE: CAZIP CODE:
92109
CAPACITY:90CENSUS: 48DATE:
12/09/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Marisa Henson and Tyler RobinsonTIME COMPLETED:
03:50 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Elise Read conducted an unannounced Case Management inspection for the purpose of following up on an incident that was self reported on 11/18/2019. LPA met with Site Director, Marisa Henson. Program Director Tyler Robinson arrived approximately 2:40PM and met with LPA at this time. Present at the time of the inspection were 48 children in the cafeteria supervised by staff Marisa Henson, Dante Viscarra, David Bobadilla, and Madison Schuette. Appropriate ratio and capacity were observed.

The incident occurred on 11/15/2019 when child C1 was sent by staff member S1 to staff member S2 while S2 had a group of 8 children using the restroom. S2 did not hear the radio communication that C1 was being sent to the bathroom. Therefore, S2 left the bathroom area with the same 8 children that were originally in the group. C1 was found a few moments later near the bathroom by S3, who was taking another group of children to the restroom. S3 kept C1 with their group until they returned to the cafeteria and playground area.

During today's inspection, LPA Read spoke with multiple staff members, reviewed child's record, and toured the facility. Staff members shared that they are no longer sending children to other staff members without verbal confirmation of radio communication and visual confirmation that the staff member has the child. The facility has also implemented using supplemental rosters that are used by each staff member to account for every child they have in their group each time they separate.

Please see LIC 809D for cited deficiencies.

An exit interview was conducted with the licensee. The licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. LPA provided Notice of Site Visit and observed it being posted.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Elise ReadTELEPHONE: (619) 767-2240
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2019
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 2
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: YMCA BARNARD ELEMENTARY PROGRAM
FACILITY NUMBER: 376701007
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/09/2019
Section Cited

1
2
3
4
5
6
7
No child(ren) shall be left without the supervision of a teacher at any time...Supervision shall include visual observation. This requirement was not met as evidenced by:
8
9
10
11
12
13
14
Based on record review and interview with staff, licensee did not ensure that child C1 was visually supervised at all times, which poses a potential Health, Safety, or Personal Rights risk to children in care.
8
9
10
11
12
13
14
policies, and had follow up meetings with staff regarding preventing these incidents from reoccurring. LPA Read was provided with copies of the supplemental rosters and staff meetings.

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Elise ReadTELEPHONE: (619) 767-2240
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2