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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701088
Report Date: 11/07/2023
Date Signed: 11/08/2023 07:44:45 AM

Document Has Been Signed on 11/08/2023 07:44 AM - 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:SAY - JEFFERSON EXTENDED DAY PROGRAMFACILITY NUMBER:
376701088
ADMINISTRATOR:IRIZ STONEFACILITY TYPE:
840
ADDRESS:3770 UTAH STREETTELEPHONE:
(858) 380-8817
CITY:SAN DIEGOSTATE: CAZIP CODE:
92104
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: 45DATE:
11/07/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Jasmine McInerneyTIME COMPLETED:
04:15 PM
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On 11/07/2023 at 2:15 p.m. Licensing Program Analyst, Cindy Meier conducted an unannounced annual inspection and met with Site Supervisor, Jasmine McInerney. LPA disclosed the purpose of the inspection and toured the inside and outside of the facility. This is an after-school program that operates during a traditional school year. Days and hours of operation are Monday, Tuesday, Thursdays, Fridays 2:00 p.m. – 6:00 p.m., Wednesdays 12:00 p.m. – 6:00 p.m. There are two classrooms in operation. The following ratios were observed: 45 school age children with four (4) staff members.

Furniture and equipment in the classrooms were observed to be in good condition, free of sharp, loose, or pointed parts. The surface of the outdoor activity space and playground equipment is maintained, is in safe condition and is free of hazards. The area under high climbing equipment and slides has cushioning to absorb falls. The playground area includes a shaded rest area for children through the use of canopies and trees.

Toilet and handwashing equipment are in safe and sanitary operating condition. Bathrooms provide individual privacy. Floors in the facility are clean and safe. Drinking water is available both indoors and outdoors. Facility has a functioning carbon monoxide detector that meets statutory requirements.

Site Supervisor stated there are no bodies of water or on the premises and LPA did not observe any bodies of water. Site Supervisor stated there are no firearms, weapons, or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, and other hazardous items are made inaccessible to children. No poisons were observed during the inspection.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Cindy Meier
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2023
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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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: SAY - JEFFERSON EXTENDED DAY PROGRAM
FACILITY NUMBER: 376701088
VISIT DATE: 11/07/2023
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A review of staff records on this date indicates facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. 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.

All required notices, forms and license(s) were posted. Capacity and limitations as specified on the license are being maintained. At least one person trained in EMSA approved Pediatric CPR and First Aid is present when children are at the facility or at offsite activities. The name of the Site Supervisor or fully qualified teacher, designated to act in the Site Supervisor’s absence, has been reported to the Department. Children are under supervision, including visual supervision, of a teacher at all times. The person who signs the child out of the facility shall use their full signature and record the time of day. Sign out sheets reviewed and observed by the LPA meet this regulation. Facility maintains a ratio of one teacher supervising no more than 14 school age children in care.

LPA reviewed a sample of children’s files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child and medical assessment. LPA reviewed a sample of staff files and observed files were complete with health screening, immunization records for influenza, pertussis, and measles, and current documentation of completed mandated reporter training.

Incidental Medical Services were discussed. (IMS). Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link ttps://www.ada.gov/childqanda.htm.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Cindy Meier
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
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: SAY - JEFFERSON EXTENDED DAY PROGRAM
FACILITY NUMBER: 376701088
VISIT DATE: 11/07/2023
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Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, no deficiencies were cited.

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.

Exit interview conducted and report was reviewed with Site Supervisor, Jasmine McInerney. A copy of this report, along with Appeal Rights (LIC9058), were provided. A Notice of Site Visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Cindy Meier
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
LIC809 (FAS) - (06/04)
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