376600593-10-7-2022-51-CC-NDIZ-CJYSWT-20221007141453

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376600593
Report Date: 10/07/2022
Date Signed: 10/07/2022 03:11:19 PM

Document Has Been Signed on 10/07/2022 03:11 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:	MISSION VALLEY YMCA - SCHOOL OF THE MADELEINE		FACILITY NUMBER:	376600593
ADMINISTRATOR:	JADA FIELDS		FACILITY TYPE:	840
ADDRESS:	1875 ILLION STREET		TELEPHONE:	(619) 276-6545
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92110
CAPACITY: 130	TOTAL ENROLLED CHILDREN: 52	CENSUS: 28	DATE:	10/07/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Emilie Hayes		TIME COMPLETED:	02:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 10/7/2022 @ 12:45PM, LPA Nancy Diaz conducted an unannounced inspection. LPA met with Emilie Hayes, Interim Site Supervisor. Observed present today were 28 school-age children. Staff Andrea Arroyo and Megan Bernardo were observed supervising the children today. A tour of the facility was conducted. The children have access to the modular classroom and outdoor lunch area. On rainy days, children have access to Rooms 5A, 5B, 6A and 6B. Program operates M-F - AM 6:30AM To 8:00AM - PM 2:45PM to 6:00PM; minimum days - 12:00noon to 6PM. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. The licensee has not exceeded the conditions, limitations and capacity specified on the license. Site Supervisor and another staff have a current CPR & First Aid certificate (EMSA approved) - Emilie Hayes and Andrea Arroyo. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are inaccessible. Medications are kept in a safe place, inaccessible to children. Furniture and equipment are in good condition, free of sharp, loose or pointed parts. All toilets, handwashing facilities are in safe and sanitary operating condition. All floors are clean and safe. The child care center was observed to be clean, safe, sanitary and in good repair to ensure the safety and well-being of children, employees and visitors. Facility maintains a carbon monoxide detector that meet the standards established in Chapter 8 of Part 2 of Division 12. The surface of the outdoor activity space are maintained in safe condition and free of hazards. Children were observed to be under the supervision of qualified staff. Facility was observed to be within ratio. An isolation area has been designated for children who becomes ill during the day.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MISSION VALLEY YMCA - SCHOOL OF THE MADELEINE	FACILITY NUMBER: 376600593
	VISIT DATE: 10/07/2022

NARRATIVE

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Children’s records were reviewed today. All required forms were on file. Menus are posted in a place visible by the child’s authorized representative. All children are signed in/out by a representative who uses a full legal signature and has recorded the time of day. Child’s record also contain a medical assessment.

Staff records reviewed today contain a health screening as required by the regulation.
Staff have completed the mandated reporter training (effective 3/2018). This training shall be renewed every two years. All staff have immunization record indicating that they have been immunized against influenza, pertussis and measles.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Site Supervisor was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MISSION VALLEY YMCA - SCHOOL OF THE MADELEINE	FACILITY NUMBER: 376600593
	VISIT DATE: 10/07/2022

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Exit interview was conducted and licensing report was reviewed with the Interim Site Supervisor, Emilie Hayes. A copy of the licensing report, appeal rights and notice of site visit were provided with Emilie Hayes. Notice of site visit was observed posted and shall remain posted for 30 days.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/07/2022 03:11 PM - It Cannot Be Edited

Created By: Nancy Diaz On 10/07/2022 at 02:00 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: MISSION VALLEY YMCA - SCHOOL OF THE MADELEINE	FACILITY NUMBER: 376600593
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/07/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101515(b)

School-Age Child Care Center Director Qualifications and Duties

(b) All school-age child care centers shall have a director. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview with Margaret Giuffre (Area Supervisor), the licensee did not comply with the section cited above. Licensee failed to notify the department when Interim Site Supervisor, Emilie Hayes was designated site supervisor this school year. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/14/2022
	Plan of Correction
1 2 3 4	Licensee shall submit form LIC 308 (Designation of Facility Responsibility) to the department (with attachments) no later than 10/14/2022.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Tashima Daniel

LICENSING EVALUATOR NAME:

Nancy Diaz

LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022

LIC809 (FAS) - (06/04)

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