<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701126
Report Date: 01/04/2024
Date Signed: 01/04/2024 04:26:05 PM

Document Has Been Signed on 01/04/2024 04:26 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:YMCA - MCKINLEY ELEMENTARYFACILITY NUMBER:
376701126
ADMINISTRATOR:SHANYCE SAMUELUFACILITY TYPE:
840
ADDRESS:3045 FELTON STREETTELEPHONE:
(619) 282-7694
CITY:SAN DIEGOSTATE: CAZIP CODE:
92104
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 71DATE:
01/04/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Shanyce SamueluTIME COMPLETED:
01:45 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 1/04/24 at 12:45 p.m. Licensing Program Analyst (LPA) Cindy Meier conducted an unannounced case management inspection to follow up on the unusual incident reported to the Department on 09/07/23. Upon arrival, LPA met with Site Supervisor Shanyce Samuelu and discussed the purpose of the inspection. LPA was led on a tour of the facility. There were seventy-one (71) children and eight (8) staff present during the inspection.

Based on interviews conducted, it was determined that on 09/06/23, Child #1 (C1) wandered away from the after-school program while transitioning from the bathroom to the classroom and was unsupervised for approximately five (5) minutes. C1 walked back to their elementary school classroom, which is located on the same campus and elementary teacher (S1) escorted C1 to the elementary school office. The office staff then escorted C1 back to the after-school program.

Sign-in sheets and staff attendance records for 09/06/23 were obtained and reviewed by LPA, and it was determined that the facility was out of the required teacher-child ratio from 3:00 p.m. to 4:20 p.m., as there were 96 school-age children in attendance and six (6) staff members.

Per California Code of Regulations, (Title 22, division 12 & Chapter 1) two (2) Type A citations are being cited on the attached LIC 809-D. A Civil Penalty in the amount of $250.00 is being assessed for a repeat violation of the same regulation subsection within a 12-month period.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Cindy Meier
LICENSING EVALUATOR SIGNATURE: DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/04/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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: YMCA - MCKINLEY ELEMENTARY
FACILITY NUMBER: 376701126
VISIT DATE: 01/04/2024
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
LPA Cindy Meier informed Site Supervisor, Shanyce Samuelu, that this report dated 1/04/24 document(s) (2) Type A citations which shall be posted for 30 consecutive days as there is immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Cindy Meier informed the Site Supervisor, Shanyce Samuelu to provide a copy of this licensing report dated 1/04/24 that documents Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with Site Supervisor, Shanyce Samuelu. 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: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 01/04/2024 04:26 PM - It Cannot Be Edited


Created By: Cindy Meier On 01/04/2024 at 08:51 AM
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: YMCA - MCKINLEY ELEMENTARY
FACILITY NUMBER: 376701126

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/04/2024
Section Cited
CCR
101229(a)(1)

1
2
3
4
5
6
7
101229(a)(1) Responsibility for Providing Care and Supervision
The licensee shall provide care and supervision as necessary...No child(ren) shall be left without the supervision of a teacher at any time...Supervision shall include visual observation.

This requirement was not met as evidenced by:

1
2
3
4
5
6
7
Childcare Director and Site Supervisor will review current supervision procedures to ensure they cover visual supervision and transitions, along with conducting a staff in-service training that addresses the topics of visual supervision and transitions. Childcare Director and Site Supervisor will provide a written statement of these procedures, date, and agenda of training to SDRO by 1/12/24.
8
9
10
11
12
13
14
Based on interviews conducted and records reviewed, the licensee did not comply with the section cited above, as C1 wandered away and was without supervision of program staff for approximately five (5) minutes which poses an immediate Health and Safety risk for children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Cindy Meier
LICENSING EVALUATOR SIGNATURE:
DATE: 01/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/04/2024


LIC809 (FAS) - (06/04)
Page: 4 of 4
Document Has Been Signed on 01/04/2024 04:26 PM - It Cannot Be Edited


Created By: Cindy Meier On 01/04/2024 at 08:55 AM
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: YMCA - MCKINLEY ELEMENTARY
FACILITY NUMBER: 376701126

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/04/2024
Section Cited
CCR
101516.5(b)(1)

1
2
3
4
5
6
7
(b) There shall be a staffing ratio of…(1) A teacher shall supervise no more than 14 children...

This requirement was not met as evidenced by:

1
2
3
4
5
6
7
Childcare Director and Site Supervisor will review current staffing schedules to ensure the facility is in compliance with regulations regarding teacher-child ratios. Childcare Director and Site Supervisor will develop a plan to ensure teacher-child ratios are met at all times and will submit a plan of operation to meet regulations regarding teacher-child ratios to the San Diego Regional Office by 1/12/24.
8
9
10
11
12
13
14
Based on interviews conducted and records reviewed, the licensee did not comply with the section cited above, as the facility was out ratio, as six (6) teachers were supervising 96 school-age children in attendance which poses an immediate Health and Safety risk for children in care.

8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Cindy Meier
LICENSING EVALUATOR SIGNATURE:
DATE: 01/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/04/2024


LIC809 (FAS) - (06/04)
Page: 2 of 4