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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700376
Report Date: 11/30/2023
Date Signed: 11/30/2023 04:29:52 PM

Document Has Been Signed on 11/30/2023 04:29 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:CENTER FOR CHILDREN & FAMILIES AT CAL STATE SMSFACILITY NUMBER:
376700376
ADMINISTRATOR:LETISIA FORDFACILITY TYPE:
850
ADDRESS:453 LA MOREE ROADTELEPHONE:
(760) 750-8750
CITY:SAN MARCOSSTATE: CAZIP CODE:
92078
CAPACITY: 176TOTAL ENROLLED CHILDREN: 176CENSUS: 98DATE:
11/30/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Letisia FordTIME COMPLETED:
04:40 PM
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On November 30, 2023 at 2:00 p.m. Licensing Program Analyst, Leilani Curtis, conducted an unannounced inspection to follow up on two self-reported incidents. The first incident occurred on 11/08/23 and the second incident occurred on 11/16/23. LPA met with Director Letisia Ford and proceeded to tour the facility. There were 98 children with 19 staff members present. Appropriate ratio/capacity was observed. Staff members have the required background clearances and are associated to the facility. LPA interviewed the director, staff #1 (S1), staff #2 (S2), staff #3 (S3) and staff #4 (S4).

On 11/08/23 at approximately 4:00 p.m. child #1 (C1) was running in a classroom when he tripped, fell and hit his bottom lip on a table causing a wound. Staff members cleaned the wound, applied an ice pack, and comforted the child. C1’s parent was notified and given an incident report. C1 received two stiches on his lip and has returned to care. At the time of the incident there were 4 children being supervised by 2 staff members. Appropriate ratio/supervision was in place. The staff members responded to the injury appropriately. LPA inspected the classroom and found the area where the incident occurred to be safe and free of hazards.

The second incident occurred on 11/16/23 at 10:40 a.m. Child #2 (C2) was leaning over a chair to pick up something off the floor. C2 fell and hit his forehead on a chair causing a cut over his right eyebrow. Staff members administered first aid and comforted the child. C2’s parent was notified of the incident and given an incident report. C2 was taken to urgent care and received three stitches to close the cut over his eyebrow. At the time of this incident there were 15 children being supervised by 2 staff members. Appropriate ratio/supervision was in place. The staff members responded to the injury appropriately. LPA inspected the table and chairs and found them to be age appropriate and free of hazards.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2023
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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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: CENTER FOR CHILDREN & FAMILIES AT CAL STATE SMS
FACILITY NUMBER: 376700376
VISIT DATE: 11/30/2023
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Both incidents were reported to Community Care Licensing timely. The director states that on 11/10/23 a meeting was held with staff members to discuss proper supervision and classroom safety.

No deficiencies are cited.

An exit interview was conducted with the director and appeal rights (LIC 9058 1/16) were discussed. The director’s signature on this form acknowledges receipt of these rights. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA observed the director post notice of site visit.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
LIC809 (FAS) - (06/04)
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