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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370800634
Report Date: 09/04/2024
Date Signed: 09/04/2024 02:38:10 PM

Document Has Been Signed on 09/04/2024 02:38 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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:LA MESA UNITED METHODIST CHILDREN'S CENTERFACILITY NUMBER:
370800634
ADMINISTRATOR/
DIRECTOR:		NANCY BETANCOURTFACILITY TYPE:
850
ADDRESS:4690 PALM AVENUETELEPHONE:
(619) 466-8407
CITY:LA MESASTATE: CAZIP CODE:
91941
CAPACITY: 87TOTAL ENROLLED CHILDREN: 64CENSUS: 44DATE:
09/04/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:20 PM
MET WITH:Nancy BetancourtTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
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On 9/4/2024, at 12:20pm, Licensing Program Analysts (LPAs) Vicky Williamson and Angela Nguyen conducted a case management inspection. LPA met with Interim Director, Nancy Betancourt and disclosed the purpose of the inspection. There were 44 children present with 10 staff.

Interim Director, Nancy Betancourt acknowledged that on 7/19/2024, she did not report an unusual incident to the San Diego Regional Office involving Child 1 (C1) being left unsupervised inside of a classroom.

Interviews were conducted with Interim Director, Nancy Betancourt, staff, daycare children including child in question and daycare parents. Interim Director stated that she was in the process of conducting an internal investigation regarding the incident before contacting the Department. LPA and Interim Director reviewed and discussed Title 22 regulation 101212 Reporting Requirements.

Interim Director, Nancy Betancourt was reminded that unusual incidents should be reported to the Department within 24 hours of occurrence and a unusual incident report LIC 624 must be submitted within 7 days of the alleged occurrence of the incident.

Based on Interim Director's own admission and documentation, one (1) Type B deficiency of California Code of Regulations, Title 22, Division 12, Chapter 1, is being cited on the attached LIC 809D.

A copy of this report along with the Appeals Rights (LIC 9058) were provided. A Notice of Site Visit was provided and is required to be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. LPA observed Interim Director, Nancy Betancourt post Notice of Site Visit and report on the bulletin board in the lobby. Exit interview conducted with Interim Director, Nancy Betancourt.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE: DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/04/2024
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 09/04/2024 02:38 PM - It Cannot Be Edited


Created By: Vicky Williamson On 09/04/2024 at 06:12 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: LA MESA UNITED METHODIST CHILDREN'S CENTER
FACILITY NUMBER: 370800634

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/11/2024
Section Cited
CCR
101212(d)(1)(C)

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(d)Upon the occurrence during the operation of the child care center... a report shall be made to the Department ... (1)Events reported shall include the following: (C)Any unusual incident or child absence that threatens...health or safety of any child.This requirement is not met as evidenced by:
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Interim Director stated that she will ensure that staff review the Child Care Reporting Requirements video on the CCL website and provide a staff sign in sheet and a summary of the video to the SDRO, no later than 9/11/2024.

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Based on interview, the licensee did not comply with the section cited above in that the Interim Director did not report an unusual incident to the Department involvng an absence of supervision of C1, which poses a potential health, safety or personal rights risk to persons 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:Vicky Williamson
LICENSING EVALUATOR SIGNATURE:
DATE: 09/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2024


LIC809 (FAS) - (06/04)
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