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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701131
Report Date: 11/28/2022
Date Signed: 11/28/2022 12:44:24 PM

Document Has Been Signed on 11/28/2022 12:44 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: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: 71TOTAL ENROLLED CHILDREN: 71CENSUS: 42DATE:
11/28/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Director Cristina JimenezTIME COMPLETED:
11:45 AM
NARRATIVE
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On November 28th, 2022 at 10:30 AM, Licensing Program Analyst (LPA) Jo Ann Legaspi conducted a case management inspection to follow-up on a self-reported incident that occurred on 10/13/2022. LPA advised Director Cristina 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 was empty. Room 2 had thirteen (13) children (aged 2 years) supervised by two (2) staff. Room 3 had sixteen (16) children (aged 3 years) supervised by two (2) staff. Room 4 had thirteen (13) children (aged 4 years) supervised by two (2) staff.

The director and assistant director stated there are no cameras in the preschool hallway; this was corroborated by visual observation of the absent video camera positioned in the preschool hallway.



The morning of 10/13/2022, Staff 1 (S1) was alone in the classroom with 3-4 children. A group of three (3) families, including Child 1 (C1), were dropped off inside the classroom at about 8:17 AM by their parents. (See LIC 811 Confidential Names). A parent spoke with S1 towards the other side of the room for a short conversation. At the start of this discussion, S1 saw C1 at the front end of the classroom by the room door. S1 looked away for approximately 1 - 2 seconds and then saw C1 gone. S1 opened the classroom door and saw C1 about 10.3 yards (372 inches away); they stood alone in the hallway by another classroom door which is closest towards the door which leads to the playground. S1 directed C1 to return to the classroom. The child returned to the classroom. S1 reported the incident’s time frame was about 1 -2 minutes.

Based on the obtained information, a Type A violation of California Code of Regulations, (Title 22, Division 12), is being cited on the attached LIC 809D.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE: DATE: 11/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/28/2022
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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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: COPLEY-PRICE FAMILY YMCA PRESCHOOL CHILD CARE
FACILITY NUMBER: 376701131
VISIT DATE: 11/28/2022
NARRATIVE
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LPA Jo Ann Legaspi informed Director Cristina Jimenez that this report dated (11/28/2022) documents one (1) Type A citation, which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care. Also, LPA Legaspi informed Director Cristina Jimenez to provide a copy of this licensing report dated (11/28/2022) that documents any Type A citation 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. LPA provided Director Cristina Jimenez with one (1) blank LIC 9224 form.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the Director Cristina Jimenez.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:

DATE: 11/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/28/2022 12:44 PM - It Cannot Be Edited


Created By: JoAnn R Legaspi On 11/28/2022 at 09:57 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: 11/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/28/2022
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision – “ … The licensee shall provide ... supervision ... to meet the children's needs … No child ... shall be left without the supervision of a teacher at any time … Supervision shall include visual observation …” This requirement is not met as evidenced by:
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Staff completed in-service re- training about supervision on 10/28/2022; director provided LPA with written documentation of this in-service training and attendance documentation log.
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Based on observations and interviews, the Licensee did not comply with the section cited above in that a child was left without the visual supervision of a teacher, which poses as an immediate risk to children in care.
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Director said she will provide the Department with a written statement describing what steps staff will take to ensure this incident does not recur. Director states this written statement will be provided to LPA no later than 12/12/2022.

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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: 11/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/28/2022


LIC809 (FAS) - (06/04)
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