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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701344
Report Date: 05/15/2024
Date Signed: 05/15/2024 03:49:32 PM


Document Has Been Signed on 05/15/2024 03:49 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:ESCONDIDO COMMUNITY CHILD DEV CENTER/BOYCE SITEFACILITY NUMBER:
376701344
ADMINISTRATOR:EUNICE HERRERAFACILITY TYPE:
830
ADDRESS:819 WEST NINTH AVENUETELEPHONE:
(760) 745-9215
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY:31CENSUS: 15DATE:
05/15/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Cynthia De DiosTIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analysts (LPA), Kelli Waters and Sumayya Habeebulla conducted a Case Management visit on 05/15/24 to follow up on an Unusual Incident Report (UIR) that was submitted to Licensing by the facility on 05/03/24. LPAs met with Eunice Herrera, Site Director, and Cynthia De Dios, Program Director, to discuss incident.

The Director reported the following; on 04/30/24, C1 was playing on the climbing structure located inside B5 classroom. There were three staff and three infants present in classroom. C1 lost balance and fell forward down the stairs which resulted in a cut on her forehead above her eyebrow. The injury resulted in C1 needing medical attention.
Interviews with staff and video footage of the incident, revealed that the three staff present were not actively supervising children in care which resulted in C1 falling off structure and injuring themselves.

See LIC 809-D for deficiency cited.

An exit interview was conducted, and a copy of this report was provided.
A copy of this report must be made available to the public, at the facility site, for 3 years.
SUPERVISOR'S NAME: Carlos MartinezTELEPHONE: (951) 805-5739
LICENSING EVALUATOR NAME: Kelli WatersTELEPHONE: 951-782-4200
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2024
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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Document Has Been Signed on 05/15/2024 03:49 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501


FACILITY NAME: ESCONDIDO COMMUNITY CHILD DEV CENTER/BOYCE SITE
FACILITY NUMBER: 376701344

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/15/2024
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary...(1) No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual ...
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Facility will train staff on responsibility for providing care and supervision as per Title 22 regulations and submit copies of the training to the department.
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This requirement was not met as evidenced by: Based on video footage and interviews with staff, C1 was playing on play structure unsupervised and fell off structure resulting injury to head requiring stiches.This posed an immediate health and safety risk to the children in care.
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Director will provide LIC 9224 to all parents enrolled for a period of one year and keep a copy in the child's file for review by the Department.

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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: Carlos MartinezTELEPHONE: (951) 805-5739
LICENSING EVALUATOR NAME: Kelli WatersTELEPHONE: 951-782-4200
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2024
LIC809 (FAS) - (06/04)
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