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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701126
Report Date: 02/10/2022
Date Signed: 02/15/2022 08:13:49 AM

Document Has Been Signed on 02/15/2022 08:13 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:ASHLEY BELLFACILITY TYPE:
840
ADDRESS:3045 FELTON STREETTELEPHONE:
(619) 282-7694
CITY:SAN DIEGOSTATE: CAZIP CODE:
92104
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: 38DATE:
02/10/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Emilie HayesTIME COMPLETED:
05:00 PM
NARRATIVE
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On February 10, 2022 at 3:00 PM Licensing Program Analysts (LPAs), Adrian Castellon and Cindy Meier, conducted an unannounced Case Management Inspection. LPAs met with the Site Supervisor, Emilie Hayes. LPAs arrived to investigate a self reported incident. On 11/18/2021, the facility self reported the incident to the SDCCRO. The facility reports that on 11/17/2021 at approximately 3:30 PM, a 7 year old child #1 left the group as the group was transitioning to the blacktop from the snack area. The child left the group to retrieve her backpack from classroom B-23. The child was unaccounted for between 10-15 minutes. One staff member notified the site supervisor that the child was unaccounted for and the site supervisor located the child. On today's date, LPAs conducted interviews with the site supervisor and child involved in the incident. Site supervisor verified that the child was unaccounted for 10-15 minutes. Child's parent was advised of the incident at the tine of pickup. The incident was reported in accordance with licensing requirements. A type A deficiency is cited on today's date. Please see LIC809D.

LPAs explained the case management incident inspection report, and the Director stated she understood. An exit interview was conducted, and a copy of the report will be emailed to the Site Supervisor due to printer issue. LIC9224 requirement was discussed. The Site Supervisor was advised that acknowledgement of the receipt of the report is to be received within 24 hours. Notice of Site Visit must be posted for 30 days.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Adrian Castellon
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2022
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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Document Has Been Signed on 02/15/2022 08:13 AM - It Cannot Be Edited


Created By: Adrian Castellon On 02/10/2022 at 04:17 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: YMCA-MCKINLEY ELEMENTARY
FACILITY NUMBER: 376701126

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/10/2022
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision: (a)The licensee shall provide care and supervision as necessary to meet the children's needs. (1)No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1).
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A Zoom meeting was held on 01/08/22 with all staff to discuss supervision requirements and safety practices. A Weekly Roster Headcount is maintained. Staff member was terminated.
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Supervision shall include visual observation. This requirement was not met as evidenced by: staff failed to properly supervise and account for a child in care which poses an immediatel health and safety risk to children in care.
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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:Cynthia Gray
LICENSING EVALUATOR NAME:Adrian Castellon
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2022


LIC809 (FAS) - (06/04)
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