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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701131
Report Date: 12/15/2021
Date Signed: 12/15/2021 10:43:30 AM

Document Has Been Signed on 12/15/2021 10:43 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:COPLEY-PRICE FAMILY YMCA PRESCHOOL CHILD CAREFACILITY NUMBER:
376701131
ADMINISTRATOR:CRISTINA JIMENEZFACILITY TYPE:
850
ADDRESS:4300 EL CAJON BOULEVARDTELEPHONE:
(619) 280-9622
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY: 90TOTAL ENROLLED CHILDREN: 90CENSUS: 26DATE:
12/15/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
07:50 AM
MET WITH:Cristina JimenezTIME COMPLETED:
08:20 AM
NARRATIVE
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On December 15th, 2021 at 7:50 AM, Licensing Program Analyst (LPA) Jo Ann Legaspi conducted a case management inspection to follow-up on an incident that occurred on 11/30/2021. LPA advised Director Jimenez of the meeting’s purpose and was granted facility entry.

The facility serves children ages 2 – 5 years. The following ratios were observed in 4 classrooms: Room 1 had five (5) children (aged 2 years) supervised by two (2) teachers. Room 2 had twelve (12) children (aged 3 years) supervised by two (2) teachers. Room 3 had nine (9) children (age 4 years) supervised by two (2) teachers. Room 4 was empty. LPA observed the children to be involved in indoor activities. Appropriate ratios were maintained, and visual observation noted. Staff present had required criminal background clearances.

On 12/01/2021, the facility self reported an incident which occurred on 11/30/2021. On 11/29/2021, a responsible parent removed an individual from a child's pick up list. On 11/30/2021, staff released the child to that unauthorized individual. When administrative staff discovered the child had been taken by the unauthorized individual, they contacted that individual who returned the child that same day. Based on the incident, a deficiency was observed and described on the LIC 809D.

A Notice of Site Visit (LIC 9213) is to be posted for thirty (30) days. Staff was provided with A Notice of Site Visit (LIC 9213), which was posted during this inspection. An exit interview was conducted with Director Jimenez. Licensee/Appeal Rights (LIC 9098 01/16) along with a copy of this report was provided to Director Jimenez and their signature on this form confirms receipt of these rights.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE: DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2021
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 12/15/2021 10:43 AM - It Cannot Be Edited


Created By: JoAnn R Legaspi On 12/15/2021 at 03:41 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: COPLEY-PRICE FAMILY YMCA PRESCHOOL CHILD CARE
FACILITY NUMBER: 376701131

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/15/2021
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care & Supervision – “… The licensee shall provide care & supervision as necessary to meet the children's needs … No child... shall be left without the supervision of a teacher at any time ... " This requirement was not met as evidenced by: an unauthorized person retrieved a child from
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The director has individually informed and written to all staff of the change in authorized individuals who may retrieve the child. The director also completed a staff meeting regarding the change in the child's authorized pick up list. This deficiency has been cleared.
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care. Upon facility contact, the individual returned the child back to the center on the same day. Based on interviews and record reviews, the Licensee failed to provide care & supervision by releasing a child to an unauthorized individual, which poses as a potential 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:Tulam Vu
LICENSING EVALUATOR NAME:JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:
DATE: 12/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/15/2021


LIC809 (FAS) - (06/04)
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