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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701117
Report Date: 01/14/2021
Date Signed: 01/14/2021 10:26:35 AM

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:EPISCOPAL COMMUNITY SERVICES - BOYS & GIRLS CLUBFACILITY NUMBER:
376701117
ADMINISTRATOR:DENISE TREJOFACILITY TYPE:
850
ADDRESS:1430 D AVENUETELEPHONE:
(619) 228-2800
CITY:NATIONAL CITYSTATE: CAZIP CODE:
91950
CAPACITY:45CENSUS: 0DATE:
01/14/2021
TYPE OF VISIT:Case Management - IncidentANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Nerissa Torralba, Belinda Rick and Denise TrejoTIME COMPLETED:
10:20 AM
NARRATIVE
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On 01/14/2021 at 10 AM, Licensing Program Analyst (LPA) Jo Ann Legaspi conducted a case management inspection to follow up on an incident that occurred on 02/28/2020. Due to the COVID 19 outbreak, this inspection was done as a tele visit upon the Zoom platform. LPA advised Nerissa Torralba (Program Manager), Belinda Rico (Area Supervisor) and Denise Trejo (Director) of the meeting’s purpose. No children were at the center due to the COVID 19 pandemic.

A child’s personal rights were violated on 02/28/2020. The incident was self reported by the facility and a written report was received in the Licensing office within the required reporting period. There were 17 children with 3 staff during the incident. On 02/28/2020, Staff 1 (S1) violated the child’s personal rights. S2 alerted the center's management of the incident. (See LIC 811 Confidential Names). Center staff investigated the matter and terminated S1. Center staff also completed staff training on the personal rights of children. LPA interviewed Staff 1 -3. The affected child no longer attends the center because of their graduation to transitional kindergarten. Efforts to interview that child and their legal representative were unsuccessful. The center’s video tape of the incident was also viewed.

Staff was provided with A Notice of Site Visit (LIC 9213), which is to be posted for thirty (30) days. LPA will electronically provide staff with this form. An exit interview was conducted. A copy of this report and Licensee/Appeal Rights (LIC 9058) will be e-mailed to staff. Staff was advised that acknowledgement of the receipt of the report is to be received within twenty-four hours.



SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: JoAnn R LegaspiTELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2021
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: EPISCOPAL COMMUNITY SERVICES - BOYS & GIRLS CLUB
FACILITY NUMBER: 376701117
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/14/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/14/2021
Section Cited

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Personal Rights - “… The licensee shall ensure that each child is ... free from … humiliation …” This requirement is not evidenced by S1 violated the child’s personal rights on 02/28/2020. S2 alerted the center’s management of the incident.
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S1 was terminated from employment due to the incident. Staff was retrained on personal rights. Based on interviews and record reviews, the Licensee failed to ensure the child’s personal rights were protected on 02/28/2020, which poses as a potential risk 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: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: JoAnn R LegaspiTELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:
DATE: 01/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/14/2021
LIC809 (FAS) - (06/04)
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