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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372006509
Report Date: 07/17/2024
Date Signed: 07/17/2024 01:38:36 PM

Document Has Been Signed on 07/17/2024 01:38 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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:BETHLEHEM COMMUNITY EARLY CHILDHOOD CENTERFACILITY NUMBER:
372006509
ADMINISTRATOR/
DIRECTOR:		D. CARR/K. PEREZFACILITY TYPE:
850
ADDRESS:925 BALOUR DRIVETELEPHONE:
(760) 753-4780
CITY:ENCINITASSTATE: CAZIP CODE:
92024
CAPACITY: 110TOTAL ENROLLED CHILDREN: 110CENSUS: DATE:
07/17/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Director Kelly PerezTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
NARRATIVE
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On 7/17/24 @9:30AM, Licensing Program Analyst (LPA) Patrick Ma, made an unannounced Case Management inspection to follow up on self reported incident reported to the Department on 6/11/24. Upon arrival, LPA met with Co-Director Kelly Perez, for the part-day program. LPA conducted interviews with staff and children and made a confidential names list.

During investigation interviews with staff, children and parents, it was determined inappropriate touching between child C1 and C5 occurred at the facility between 5/20/24 - 5/21/24 due to a lack of supervision. Facility was within ratio but incident was not observed by staff. Per California Code of Regulations, (Title 22, Division 12, Chapter 1) the deficiency is being cited on the attached LIC 9099D.

LPA Patrick Ma informed Director Kelly Perez that this report dated 7/17/24 documents one Type A citation which shall be posted for 30 consecutive days as there was immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Ma informed the Director to provide a copy of this licensing report dated 7/17/24 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.

Exit interview conducted and report was reviewed with Director Kelly Perez. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Patrick Ma
LICENSING EVALUATOR SIGNATURE: DATE: 07/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/17/2024
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 07/17/2024 01:38 PM - It Cannot Be Edited


Created By: Patrick Ma On 07/17/2024 at 12:23 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: BETHLEHEM COMMUNITY EARLY CHILDHOOD CENTER
FACILITY NUMBER: 372006509

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/18/2024
Section Cited
HSC
101229(a)(1)

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101229(a)(1) Responsibility for Providing Care and Supervision: (1) No child(ren) shall be left without the supervision of a teacher at any time…Supervision shall include visual observation. This requirement was not met as evidenced by:
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Director stated she will provide a training summary/agenda on supervision to the Department by 7/18/24. Then conduct the training with staff and provide sign-in sheet proof of all staff participation by 7/26/24.
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Based on investigation interviews with staff, children and parents, it was determined inappropriate touching between child C1 and C5 occurred at the facility between 5/20/24 - 5/21/24 due to a lack of supervision which posed an immediate health, safety or personal rights 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:Renesha Askew
LICENSING EVALUATOR NAME:Patrick Ma
LICENSING EVALUATOR SIGNATURE:
DATE: 07/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/17/2024


LIC809 (FAS) - (06/04)
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