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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372005598
Report Date: 11/04/2021
Date Signed: 11/04/2021 12:27:59 PM

Document Has Been Signed on 11/04/2021 12:27 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: 80DATE:
11/04/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Director Karisa RiddleTIME COMPLETED:
12:40 PM
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On 11/4/21 @ 11:00 a.m., Licensing Program Analysts Joelle Redding and Daniel Pena, made an unannounced visit to evaluate the circumstances surrounding a self-reported incident wherein a staff member restrained a child in the classroom.

During this visit, LPAs interviewed the Director, Karisa Riddle and Staff #1 who were witnesses to the situation as it occurred. Staff #2, also a witness to the situation, was not present today. As this class is a M/W/F class, there were no children on site from the classroom to speak with today. Supportive documentation and contact information was obtained.

No deficiencies are cited. Evaluation is ongoing at this time.
SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Joelle Redding
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2021
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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