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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701088
Report Date: 08/31/2021
Date Signed: 08/31/2021 06:34:22 PM

Document Has Been Signed on 08/31/2021 06:34 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: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: 0CENSUS: 28DATE:
08/31/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Sheila Skinner, Site SupervisorTIME COMPLETED:
06:30 PM
NARRATIVE
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On 08/31/2021, at 4:30PM, LPA, Luigi Gargaro, conducted a case management visit to the school site today for a room change that was requested by the facility. Analyst met with Site Supervisor Sheila Skinner and then toured the classrooms and outdoor space.

The facility, which was conducting their school age program in classrooms 2 and 201, submitted a room change application to substitute room 208 for the previously used classroom 2 and also continue care in room 201. During today's visit, the facility was operating in classroom 208 prior to it being inspected and approved. The facility was also operating out of ratio as classroom 201 had 19 children in care under the supervision of Site Supervisor Skinner while classroom 208 had 9 children under the supervision of staffer Sara Sandoval.

Analyst inspected both classrooms during today's visit. Both rooms had appropriate, furniture, equipment and materials for school age children. All equipment was found to be in good condition. Disinfectants, cleaning solutions, and other items that are dangerous to children, are inaccessible via storage in latched cabinet. The facility is clean, safe, sanitary, and in good repair at all times to ensure the safety and well-being of children, employees and visitors. Facility has a functioning carbon monoxide detector and fire extinguisher that meet statutory requirements. Restrooms are located immediately adjacent to classroom 208 and are used by both classrooms. A second set of restrooms are located on the second floor and are solely used by older children when escorted by staff. Restrooms were sanitary and safe for use. Drinking water is available both indoors and out.

Outdoor play area is immediately behind the classroom and has age appropriate equipment and cushioning. Fire clearance for the two rooms was approved by SDFD on 08/25/21.

Facility was cited a type B violation today for the out of ratio violation. Approval of classroom is pending review. Analyst left a Notice Of Site Visit for program site supervisor to post in facility notice area for 30 days.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2021
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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Document Has Been Signed on 08/31/2021 06:34 PM - It Cannot Be Edited


Created By: Luigi Gargaro On 08/31/2021 at 05:48 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 - JEFFERSON EXTENDED DAY PROGRAM
FACILITY NUMBER: 376701088

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/31/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/03/2021
Section Cited
CCR
101516.5(1)

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101516.5 Teacher-Child Ratio (1) A teacher shall supervise no more than 14 children or with an aide a maximum of 28 children. This requirement was not met as evidenced by:
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The violation was corrected as children were picked up during analyst's visit by parents putting the staffer and classroom back in appropriate ratio. Site supervisor advised analyst that the facility currently has 46 children enrolled with only the two current classroom teachers.
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Based on analyst review, site supervisor had 19 children under her supervision at the time of analyst's arrival. Having more than the 1:14 child to staff ratio is a potential risk to children in care.
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Site supervisor and program director to submit a statement to analyst by 09/03/21 advising what action the facility will be taking to ensure required ratios are being met. Site supervisor provided analyst with a current copy of the facility personnel report. Analyst will also review deficiency and current staffing situation with manager and determine any further needed actions.

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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:Jason Garay
LICENSING EVALUATOR NAME:Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2021


LIC809 (FAS) - (06/04)
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