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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701126
Report Date: 11/17/2022
Date Signed: 11/29/2022 09:11:01 AM

Document Has Been Signed on 11/29/2022 09:11 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:YMCA - MCKINLEY ELEMENTARYFACILITY NUMBER:
376701126
ADMINISTRATOR:EMILY HAYESFACILITY TYPE:
840
ADDRESS:3045 FELTON STREETTELEPHONE:
(619) 282-7694
CITY:SAN DIEGOSTATE: CAZIP CODE:
92104
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 61DATE:
11/17/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Taylor PlatteTIME COMPLETED:
04:45 PM
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On 11/17/2022 at 2:50pm, Licensing Program Analyst (LPA) Cindy Meier conducted an unannounced Case Management inspection regarding an incident that occurred on 11/3/22. Upon arrival, LPA advised Site Supervisor, Taylor Platte the purpose of the inspection and was led on a tour of the facility. Present during the inspection were 61 children and eight (8) staff.

On 11/3/22 the facility self reported an Unusual Incident where according to staff witnesses, the elementary janitor physically picked child, C1 up, and forcefully put C1 down on the bench.

During the inspection the LPA interviewed two (2) staff members, site supervisor, associate principal, and three (3) children.

No deficiencies issued during today's visit.
An exit interview was conducted with Site Supervisor, Taylor Platte and the following was provided: LIC809, appeal rights and LIC9213-Notice of Site Visit. LPA informed Site Supervisor that the Notice of Site Visit must be posted for 30 days from today's date.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Cindy Meier
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2022
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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