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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701072
Report Date: 06/16/2021
Date Signed: 06/16/2021 02:00:05 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:MAOF SAN YSIDRO EARLY LEARNING CENTERFACILITY NUMBER:
376701072
ADMINISTRATOR:ADRIANA AARONFACILITY TYPE:
850
ADDRESS:1901 DEL SUR BLVD., 1ST FLOORTELEPHONE:
(619) 621-2525
CITY:SAN YSIDROSTATE: CAZIP CODE:
92173
CAPACITY:96CENSUS: 35DATE:
06/16/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Angelica Nunez, Facility RepresentativeTIME COMPLETED:
02:00 PM
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On June 16, 2021 at 10:40 AM, Licensing Program Analyst (LPA), Marie Hernandez conducted a case management inspection due to an incident that occurred on 05/27/2021. LPA met with the Facility Representatives, Angelica Nunez, Josephine Bartolo, and Norma Amezcua. Present are thirty five children with fourteen staff. On 05/28/2021, the facility self reported the incident to the Department. The facility reports that on 05/27/2021 at approximately 9:20 AM, the staff person in question handled child #1 inappropriately and spoke to the child inappropriately. During the case management inspection, LPA conducted several interviews with several staff and several children. The staff person in question no longer works at the facility. However, the incident requires further review due to insufficient information available at this time.

LPA Marie Hernandez explained the case management incident inspection report, and the Representative, Angelica Nunez, stated it is understood. An exit interview was conducted, and a copy of the report and the notice of site visit was provided to the Representative. The Representative was advised that the notice of site visit must be posted for 30 days.
SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Marie HernandezTELEPHONE: (619) 767-2244
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021
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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