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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372005598
Report Date: 09/29/2022
Date Signed: 09/29/2022 05:07:58 PM

Document Has Been Signed on 09/29/2022 05:07 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: 71DATE:
09/29/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Director Karissa RiddleTIME COMPLETED:
02:25 PM
NARRATIVE
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On 9/29/2022 @ 2:00 p.m., Licensing Program Analsyt (LPA), Joelle Redding, made an unannounced visit due to a positive lead result from the South kitchen water faucet, attached to Room 105.

LPA spoke with Director Karissa Riddle. This sink has not been used for drinking, however it was used for food prep prior to the pandemic. The facility has had the problem addressed since the report, however the faucet continues to test positive. The next step is to install a water filter. The faucet has not been used since the report and there is another kitchen where the faucets have passed inspection that is now used as food prep for snacks. A Type A deficiency will be cited on the accompanying LIC 809D.

LPA informed the Director to provide a copy of this licensing report dated 9/20/22 that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. Form was provided during the visit. LPA informed Director that this report, dated 9/20/22 and documenting one Type A citation, shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Exit interview conducted and report was reviewed with Director.

NOTICE OF SITE VISIT WAS GIVEN AND WILL REMAIN POSTED FOR 30 DAYS. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Joelle Redding
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2022
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 09/29/2022 05:07 PM - It Cannot Be Edited

Citations on this Visit Report are Under Appeal!


Created By: Joelle Redding On 09/29/2022 at 12:03 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MAGDALENA ECKE YMCA
FACILITY NUMBER: 372005598

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
09/23/2022
Section Cited

10703(b)(1)

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Written Directives: A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.

This requirement is not met as evidenced by:
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Director states that when the facility stopped providing food due to the pandemic, the sink in question was no longer used for food prep and has not been used since. After the report, the facility has replaced the sink and flushed the lines several times, however it still continues to test positive. The next step will be to install a water filter. There is another kitchen that
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Based on water testing results and interviews, the faucet in the South kitchen area (attached to Room 105) tested over the Action Level Exceedance level. This sink had been used for food prep prior to the pandemic. This was an immediate health, safety or personal rights risk to children in care.
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has food prep faucets which passed the water sample testing and this is the sink that has been used since they restarted serving snack. The other sink will remain off limits until it passes the testing and Director will inform Licensing when and if the sink passes and will be used again.

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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:Renesha Askew
LICENSING EVALUATOR NAME:Joelle Redding
LICENSING EVALUATOR SIGNATURE:
DATE: 09/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2022


LIC809 (FAS) - (06/04)
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