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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700653
Report Date: 01/09/2025
Date Signed: 01/09/2025 05:11:58 PM

Document Has Been Signed on 01/09/2025 05:11 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:SAY - DINGEMAN ANNEX EXTENDED DAY PROGRAMFACILITY NUMBER:
376700653
ADMINISTRATOR/
DIRECTOR:		CRYSTAL JAMESFACILITY TYPE:
840
ADDRESS:11840 SCRIPPS CREEK DRIVETELEPHONE:
(858) 688-2160
CITY:SAN DIEGOSTATE: CAZIP CODE:
92131
CAPACITY: 72TOTAL ENROLLED CHILDREN: 21CENSUS: 19DATE:
01/09/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:30 PM
MET WITH:Hayley JamesTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
NARRATIVE
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On 1/9/25 4:30 pm, Licensing Program Analyst (LPA) Gerald Poindexter conducted an unannounced site inspection for the purpose of follow-up on an incident that occurred on 7/31/24 at around 1:30 pm. A seven-year-old child, C1, was discovered injured at the facility near the basketball court as the staff was transitioning from the play area. The child later received medical attention at a local medical facility. The incident was self-reported to Community Care Licensing by the facility with a written incident report that was received on 9/6/24, beyond the seven-day reporting requirement.

LPA met with Hayley James, Site Supervisor. Based on record review and information gathered during interviews, adequate supervision was in place at the time, but the incident was not fully observed by the staff. Staff administered care and first aid and contacted the child’s parents. The parents of C1 discussed the incident with facility leadership and LPA. The incident happened on the final day of the summer camp session.

LPA printed the reporting requirements regulation and provided it to Ms. James,

The following ratios were observed today: 19 children supervised by 2 staff members in 1 classrooms and the playground. All staff members have the required background clearances and are associated to the facility.



See LIC809D for Type B deficiency cited today:

An exit interview was conducted, and appeal rights were provided to Hayley James, site supervisor. A notice of site visit was provided, and it shall remain posted at the facility for 30 days.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Gerald Poindexter
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2025
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 01/09/2025 05:11 PM - It Cannot Be Edited


Created By: Gerald Poindexter On 01/09/2025 at 04:42 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: SAY - DINGEMAN ANNEX EXTENDED DAY PROGRAM
FACILITY NUMBER: 376700653

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/09/2025
Section Cited
CCR
101212(d)(1)(c)

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101212(d)(1)(c) Reporting Requirements: Upon the occurrence, during the operation of the child care center…(d)(1)…a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2)
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LPA printed the reporting requirements regulation and provided it to Ms. James, who stated she will ensure that any future incidents are reported to the duty line 619-767-2248 within 24 hours by phone and submitted within 7 days of the
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below shall be submitted to the Department within seven days following the occurrence of such event. (1) Events reported shall include the following:(C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child. This requirement was not met as evidenced by:

Based on record review and interviews, the facility did not report to the Department an incident from 7/31/24 involving an injured child, which posed a potential risk to the health, safety, or personal rights of children in care.
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incident occurring via Unusual Incident Report by email to SDIncidentReports@dss.ca.gov or by Fax at 619-767-2203.

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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:Joelle Redding
LICENSING EVALUATOR NAME:Gerald Poindexter
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2025


LIC809 (FAS) - (06/04)
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