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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701078
Report Date: 06/11/2021
Date Signed: 06/11/2021 12:56:41 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:EASTER SEALS CHILD DEVELOPMENT CENTERFACILITY NUMBER:
376701078
ADMINISTRATOR:SAMANTHA FERGUSONFACILITY TYPE:
850
ADDRESS:2240 ENCINITAS BOULEVARD STE HTELEPHONE:
(760) 635-2600
CITY:ENCINITASSTATE: CAZIP CODE:
92024
CAPACITY:70CENSUS: 32DATE:
06/11/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Director Samantha FergusonTIME COMPLETED:
12:35 PM
NARRATIVE
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On 6/11/2021 @ 11:15 a.m. Licensing Program Analyst, Joelle Redding, met with Director Samantha Ferguson, for a case management visit. The purpose of this visit it to evaluate the circumstances surrounding a self-reported incident that occurred on 5/25 wherein it was alleged that Staff #1 yelled at Child #1.

During today's visit, LPA spoke with the Director and Staff #2 and #3. The Director stated that the program had been actively working with Staff #1 and had just conducted both a classroom assessment on 4/15 and subsequent training on 5/14 with regard to "positive climate" having to do with interaction with children in the classroom. Staff #1 did eventually admit to yelling at Child #1, regardless of these steps, and was subsequently suspended.

Although the facility had taken all appropriate and preventative action to avoid any such situation, Child #1's Personal Rights were violated when Staff #1 yelled at Child #1 and causing Child #1 to cry. This is considered an immediate hazard to the health and safety of children in care and thus, a Type A deficiency is cited on the accompanying LIC 809D.

Note: Per Assembly Bill 633 (Parent Notification Requirements) the facility is to provide a copy of this Licensing Report to the parents of all children currently enrolled as well as any children newly enrolled over the next 12 month period. Parents are to sign form LIC 9224, Acknowledgment of Receipt of Licensing Reports and the form is to be kept in each child's file for Licensing's review. In addition, this Licensing report is to be posted along with the Notice of Site Visit for 30 days. LIC 9224 was provided at this visit.

Appeal Rights (1/16) were discussed and provided during this visit. Signature at the bottom of this form confirms receipt. Notice of Site visit and LIC 809/809D was posted during this visit and will remain posted for 30 day.
SUPERVISOR'S NAME: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2021
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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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: EASTER SEALS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 376701078
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/11/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/14/2021
Section Cited

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Personal Rights. he licensee shall ensure that each child is accorded the following personal rights...To be free from... intimidation, ridicule...threat or other actions of a punitive nature...

This requirement was not met as evidenced by:
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Based on interviews, on 5/25, Staff #1 yelled at Child #1, causing the child to cry. Because the child had a negative reaction as a result of the yelling, it is considered an immediate rather then potential hazard to children 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: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 06/11/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/11/2021
LIC809 (FAS) - (06/04)
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