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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701340
Report Date: 12/09/2019
Date Signed: 12/09/2019 09:57:58 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:MCKINNEY FAMILY YMCA LA JOLLA PRESCHOOLFACILITY NUMBER:
376701340
ADMINISTRATOR:BRENDA STEVENSFACILITY TYPE:
850
ADDRESS:8355 CLIFFRIDGE AVENUETELEPHONE:
(858) 453-3483
CITY:LA JOLLASTATE: CAZIP CODE:
92037
CAPACITY:96CENSUS: 57DATE:
12/09/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Brenda StevensTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Elise Read conducted an unannounced Case Management inspection with the purpose of following up on an incident that was reported on 11/18/2019. LPA met with Director Brenda Stevens. Present at the time of the inspection were 57 children with 9 staff in 5 classrooms. Appropriate capacity and ratio were observed.

The incident occurred on 11/15/2019 when C1 was climbing on a playground playhouse. C1 was climbing up the side of the playhouse attempting to get to the top. S1 was removing C1 from playhouse multiple times and attempting to redirect the child. A few minutes later, C1 attempted to climb the playhouse again. At this time, S2 removed C1 from the side of the playhouse and placed the child on the floor in front of the staff. S2 reminded C1 that feet need to stay on the floor and attempted to redirect to another activity. C1 threw himself backwards and hit his head on the pole of the playhouse. C1 sustained a cut to the head, which required medical attention.

After investigating the incident, staff handled the situation appropriately. Ratio and capacity were met and supervision was in place. LPA inspected the playground equipment, which is age appropriate for C1.

No 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)
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