376701340-8-22-2019-51-CC-TDAL-BG4UPC-20190917154516

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 376701340
Report Date: 08/22/2019
Date Signed: 08/22/2019 02:29:44 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/19/2019 and conducted by Evaluator Samantha Salunga

PUBLIC

COMPLAINT CONTROL NUMBER: 51-CC-20190819114320

FACILITY NAME:	MCKINNEY FAMILY YMCA LA JOLLA PRESCHOOL		FACILITY NUMBER:	376701340
ADMINISTRATOR:	BRENDA STEVENS		FACILITY TYPE:	850
ADDRESS:	8355 CLIFFRIDGE AVENUE		TELEPHONE:	(858) 453-3483
CITY:	LA JOLLA	STATE: CA	ZIP CODE:	92037
CAPACITY:	96	CENSUS: 0	DATE:	08/22/2019
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Brenda Stevens		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Personal Rights- Staff served daycare child food that daycare child is allergic to.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Samantha Salunga and Chanell Farnese completed an unannounced inspection for the purpose of delivering the finding for the above allegation. Upon arrival, LPAs met with Director, Brenda Stevens. There are no children present due to the facility being closed from 08/21/19-08/23/19 for in-service training. During time of inspection, LPAs conducted interviews with staff. Throughout the investigation, LPAs obtained related documentation such as email threads, client files, and sign in sheet. Based upon information gathered through interviews and supporting documents, the preponderance of evidence standard has been met. There is enough supporting information to prove that although the facility was notified about Child #1 being allergic to pork, Child #1 was provided pepperoni on 08/15/19. The above allegation is to be SUBSTANTIATED. An exit interview was conducted with Director. NOTICE OF SITE VISIT IS TO BE POSTED FOR 30 DAYS. LPAs observed Director notice of site visit. A printed copy of this report as well as a printed copy of the appeal rights was provided and reviewed with Director at the conclusion of the visit. See LIC9099D for cited deficiency.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha Salunga	TELEPHONE: (619) 767-2209
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 51-CC-20190819114320

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: MCKINNEY FAMILY YMCA LA JOLLA PRESCHOOL	FACILITY NUMBER: 376701340
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/22/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/30/2019 Section Cited CCR 101223(a)(2)	1 2 3 4 5 6 7	Personal Rights. To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This was not met as evidenced by; facility was notified about Child #1’s allergy against pork upon enrollment, however Child	1 2 3 4 5 6 7	Director states that a formal protocol for following up regarding children allergies will be provided to LPA Salunga by 08/30/2019 via email.
	8 9 10 11 12 13 14	#1 was provided pepperoni on 08/15/19. Interview with Child #1’s parent confirmed Child #1 did not sustain any allergic reaction from the incident. This poses a Potential Health and Safety risk to the clients in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	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 Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha Salunga	TELEPHONE: (619) 767-2209
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2019

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019

LIC9099 (FAS) - (06/04)

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