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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372005598
Report Date: 01/20/2023
Date Signed: 01/20/2023 12:16:23 PM

Document Has Been Signed on 01/20/2023 12:16 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: 140CENSUS: 90DATE:
01/20/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Director Karissa RiddleTIME COMPLETED:
12:25 PM
NARRATIVE
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On 1/20/2023 @ 11:40 a.m. Licensing Program Analyst (LPA), Joelle Redding, made an unannounced visit to follow up on a self-reported incident that occurred on 12/14/2022 wherein a 3 year old child (Child #1) was left behind in the classroom during a transition to the playground.

During this visit, LPA spoke with Director and reviewed Staff #1's statement. There were 12 three year old present in the classroom with Staff #1. The children had lined up on their dots to transition to the playground. There was some chaos with one of the children misbehaving, temporarily requiring Staff #1's direct attention, and Child #1, who was initially standing to go outside, sat back down and did not leave the classroom with the rest of the class. Once outside on the grass area, Staff #1 did another headcount and realized that Child #1 was not with them. She asked one of the other teachers who was in ratio on the playground to look in her room and that is where Child #1 was found, still sitting on the dot. Total elapsed time was approximately 5-7 minutes from transition to Child #`1 returning to the group. The classroom opens right onto the playground. Director conducted a refresher one-on-one transition training with Staff #1.

A Type B deficiency will be cited on the accompanying LIC 809D.

Follow up was also done for a self-reported incident that occurred on 1/10/23 wherein a 4 year old child tripped on the playground and sustained a cut to the chin. LPA spoke with Director and reviewed pertinent documentation. Ratios were in place, supervision was present and first aid was immediately applied. Facility responded to the accident appropriately. No further action is required.

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: 01/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/20/2023
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 01/20/2023 12:16 PM - It Cannot Be Edited


Created By: Joelle Redding On 01/20/2023 at 12:05 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: 01/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/03/2023
Section Cited
CCR
101229(a)

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 Care and Supervision. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1).

This requirement was not met as evidenced by:
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Immediatly upon learning of the incident, Director states she had a one on one transition refresher training with Staff #1. Transitions are also covered during regular staff meetings.
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Based on LPA's interviews and review of relevant documentation, Child #1 was left behind in the classroom without supervision for approximatley 5-7 minutes durng a transition to the playground. As the child was in safe contaned space for a short period of time, this is a potential rather then immediate risk to the health and safety of children in care.
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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: 01/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/20/2023


LIC809 (FAS) - (06/04)
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