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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700377
Report Date: 07/22/2024
Date Signed: 07/22/2024 11:18:10 AM

Document Has Been Signed on 07/22/2024 11:18 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:CENTER FOR CHILDREN & FAMILIES-INFANT AT CAL STATEFACILITY NUMBER:
376700377
ADMINISTRATOR/
DIRECTOR:		LETISIA FORDFACILITY TYPE:
830
ADDRESS:453 LA MOREE ROADTELEPHONE:
(760) 750-8750
CITY:SAN MARCOSSTATE: CAZIP CODE:
92078
CAPACITY: 38TOTAL ENROLLED CHILDREN: 30CENSUS: 21DATE:
07/22/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Director, Letisia FordTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
NARRATIVE
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On 7/22/24, an unannounced case management inspection was conducted by Licensing Program Analyst (LPA) Saraliz Velando to follow up on a self-reported incident that occurred on 7/17/24. Upon arrival, LPA met with Director, Letisia Ford. A tour of the facility was conducted, and LPA observed 9 staff and 21 infants in care.

The facility self-reported the incident to the department by phone on 7/18/24. During the incident on 7/17/24, staff fed an infant the wrong bottle. According to staff, one of the infants was given a bottle of formula with a different infant’s name and the infant takes a different type of formula than the one consumed.

Based on staff statements to the Director, Letisia Ford, it appears that the 2-step procedure in place was not followed by infant staff to make sure the infant gets the correct bottle.

Type B Violation was cited. Refer to the next page LIC 809-D for deficiency citation. Facility was provided a copy of the appeal rights.

Exit interview was conducted and report was reviewed with Director, Letisia Ford. Appeal rights were provided, and a Notice of Site Visit was posted and must remain for 30 days.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Saraliz Velando
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2024
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 07/22/2024 11:18 AM - It Cannot Be Edited


Created By: Saraliz Velando On 07/22/2024 at 10:55 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: CENTER FOR CHILDREN & FAMILIES-INFANT AT CAL STATE
FACILITY NUMBER: 376700377

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/26/2024
Section Cited
CCR
101223(a)(2)

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Personal Rights - (a)The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by:
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Director states that she will conduct person to person training with all the infant teachers and submit proof to the dept. by 7/26/24. She will also submit proof of 2 staff coaching forms to the dept by 7/26/24.
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Based on staff statements, staff did not use the existing 2-step protocol in place to make
sure the correct baby bottle was given to the correct infant. This posed a potential risk to the health and safety of infants 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:Joelle Redding
LICENSING EVALUATOR NAME:Saraliz Velando
LICENSING EVALUATOR SIGNATURE:
DATE: 07/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2024


LIC809 (FAS) - (06/04)
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