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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372005598
Report Date: 10/15/2021
Date Signed: 10/15/2021 02:47:15 PM

Document Has Been Signed on 10/15/2021 02:47 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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:MAGDALENA ECKE YMCAFACILITY NUMBER:
372005598
ADMINISTRATOR:KARISA RIDDLEFACILITY TYPE:
850
ADDRESS:200 SAXONY ROADTELEPHONE:
(760) 942-9622
CITY:ENCINITASSTATE: CAZIP CODE:
92024
CAPACITY: 152TOTAL ENROLLED CHILDREN: 152CENSUS: 90DATE:
10/15/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Director KarissaTIME COMPLETED:
02:55 PM
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On 10/15/2021 @ 2 p.m., Licensing Program Analyst, Joelle Redding, made an unannounced visit to follow up on a self-reported incident that occurred on 9/17/21 wherein Child #1 fell on the playground, sustaining a cut on the forehead requiring medical attention.

During today's visit, LPA spoke the Director and Child #1 and inspected the playground where the incident occurred. The walking logs are low, maybe 6-8 inches above the ground, in a safe arrangement, secured to the ground and age appropriate. Director was standing within 10 ft. of the child handling sign outs at the gate. Staff #1 (who was not present today but who submitted a statement of events) was a bit closer, facing the area where the incident occurred. There were approximately 14 children in the area with three of them, including Child #1, walking across the balancing logs. Staff #1 saw Child #1 lose balance and fall forward with arms out on either side of the log in front. Child #1's forehead hit the log causing a cut. Staff #1 attended to the child right away and Director took over, applying pressure to stop the bleeding. She called the Site Aquatics Director (who is fingerprint cleared and associated to the preschool), who was able to apply first aid. Child #1's parents were contacted for pick up. The injury was assessed by a physician and the cut glued. Child #1 returned to care the following Monday. Child #1's statement to LPA corroborated the events as recounted by Director and Staff #1.

Ratios were met, supervision was in place, staff responded appropriately and the facility responded timely. The area and equipment was found to be safe and age appropriate with proper use of the balancing logs by the children at the time of the incident. No hazards were noted and no deficiencies are sited.
SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Joelle Redding
LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2021
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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