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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376300488
Report Date: 07/02/2024
Date Signed: 07/02/2024 03:57:01 PM

Document Has Been Signed on 07/02/2024 03:57 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:MOTTINO FAMILY YMCA PRESCHOOLFACILITY NUMBER:
376300488
ADMINISTRATOR/
DIRECTOR:		ELIZABETH REYNOSOFACILITY TYPE:
850
ADDRESS:4701 MESA DRIVETELEPHONE:
(619) 873-7134
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY: 40TOTAL ENROLLED CHILDREN: 28CENSUS: 12DATE:
07/02/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:20 PM
MET WITH:Tonja HandleyTIME VISIT/
INSPECTION COMPLETED:
04:05 PM
NARRATIVE
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On July 2, 2024, Licensing Program Analyst (LPA) Keely Messerschmidt conducted a case management visit in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was reported to Community Care Licensing (CCL) on 6/10/2024.  

During this visit LPA conducted interviews with staff and reviewed facility records relating to incident that took place on June 10th, 2024 involving child #1 (C1). It was stated by staff that C1 was left unattended in classroom for a few minutes, teacher unknowingly left C1 in classroom while heading to the playground and front desk staff heard C1 minutes later and reunited C1 with class unharmed. See LIC-809D for cited deficiency.

An exit interview was conducted and a copy of this report, appeal rights and notice of site visit was provided to Tonja Handley.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Keely Messerschmidt
LICENSING EVALUATOR SIGNATURE: DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/02/2024
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 07/02/2024 03:57 PM - It Cannot Be Edited


Created By: Keely Messerschmidt On 07/01/2024 at 03:52 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
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: MOTTINO FAMILY YMCA PRESCHOOL
FACILITY NUMBER: 376300488

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/02/2024
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 to meet the children's needs.(1)No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections
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Director completed a training/memo with staff regarding transitions and name to face and impleted a new roster to avoid any future incidents.
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101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This was not met as evidenced by, based on interviews and record review it was stated by staff that C1 was left unattended in classroom for a few minutes. This is an immediate risk to the health and safety to the 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:Deborah Mullen
LICENSING EVALUATOR NAME:Keely Messerschmidt
LICENSING EVALUATOR SIGNATURE:
DATE: 07/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/02/2024


LIC809 (FAS) - (06/04)
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