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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372006399
Report Date: 08/10/2023
Date Signed: 08/16/2023 11:04:28 AM

Document Has Been Signed on 08/16/2023 11:04 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:UCSD EARLY CHILDHOOD EDUCATION - MAIN SITE-INFANTFACILITY NUMBER:
372006399
ADMINISTRATOR:MATTHEW PROCTORFACILITY TYPE:
830
ADDRESS:9224 REGENTS ROADTELEPHONE:
(858) 246-0900
CITY:LA JOLLASTATE: CAZIP CODE:
92037
CAPACITY: 50TOTAL ENROLLED CHILDREN: 46CENSUS: 34DATE:
08/10/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:08 AM
MET WITH:Program Coordinator, Lucia Santa Maria TIME COMPLETED:
10:40 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Jennifer Lott and Sherlynn Banas, conducted an unannounced Case Management-Incident visit. LPAs were greeted at the front of the facility by Program Coordinator, Lucia Santa Maria, and granted entry after identifying themselves and disclosing the purpose of their visit. During LPA's visit, they toured the infant classroom and yard.

The purpose of the LPA’s visit was to discuss an incident that was self reported and received in our office on 07/14/2023. Incident report indicates infant child #1 (C1) wandered out of the classroom yard through an unsecured gate and into the adjacent classroom yard.

Deficiencies are cited per Title 22 regulations and will be noted on the attached 809D.
Exit interview conducted and report reviewed with Program Coordinator, Lucia Santa Maria. A notice of site visit was given and must remain posted for 30 days.

LPAs Lott and Banas informed Program Coordinator, Santa Maria that this report dated 08/10/2023 documents one (1) type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health and safety of children in care.

Also, LPAs Lott and Banas informed Program Coordinator, Santa Maria to provide a copy of this licensing report dated, 08/10/2023, 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 Reports (LIC 9224), or other written statement must be placed in the child’s file for verification.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE: DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/10/2023
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 08/16/2023 11:04 AM - It Cannot Be Edited


Created By: Jennifer Lott On 08/10/2023 at 10:06 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: UCSD EARLY CHILDHOOD EDUCATION - MAIN SITE-INFANT
FACILITY NUMBER: 372006399

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/11/2023
Section Cited
CCR
101429(a)(1)

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Responsibility for Providing Care & Supervision for Infants -"... (1) Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times." This requirement was not met as evidenced by:
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Assistant Director states that they will provide training on direct supervision and observations. A training date will be provided by 08/11/23 and sign in sheet once training has been completed.
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Based on interviews and observations, the licensee did not meet the above requirement in that one (1) infant in care wandered out of an unlocked gate without being noticed by staff. This poses an immediate health & 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:Tashima Daniel
LICENSING EVALUATOR NAME:Jennifer Lott
LICENSING EVALUATOR SIGNATURE:
DATE: 08/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/10/2023


LIC809 (FAS) - (06/04)
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