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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700416
Report Date: 08/14/2023
Date Signed: 08/14/2023 05:10:24 PM

Document Has Been Signed on 08/14/2023 05:10 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:SKYLINE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
376700416
ADMINISTRATOR:JACQUELINE SERRANOFACILITY TYPE:
850
ADDRESS:11330 CAMPO ROADTELEPHONE:
(619) 415-5485
CITY:LA MESASTATE: CAZIP CODE:
91941
CAPACITY: 72TOTAL ENROLLED CHILDREN: 57CENSUS: 47DATE:
08/14/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:46 PM
MET WITH:Jacqueline SerranoTIME COMPLETED:
05:10 PM
NARRATIVE
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On 8/14/2023, at 2:46 pm., Licensing Program Analyst (LPA) Vicky Williamson conducted an unannounced case management inspection to cite for deficiencies. LPA met with Director, Jacqueline Serrano. LPA discussed the purpose of the inspection and was led on a tour of the facility. There are 47 children present with six (6) staff members.

During a previous investigation, it was reported and documented that Staff 1 (S1) [See Confidential Names] was observed on multiple occasions yelling and using inappropriate tones with day care children. Interviews were conducted with the directors, staff members, daycare children, and daycare parents.

LPA's review of records for S1 and facility documentation determined that S1 violated the personal rights of day care children. S1 is no longer an employee at the facility.

Director stated that a training regarding the personal rights of children was conducted with all staff on 8/11/2023.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, deficiencies were cited. See LIC 809D.

A copy of this report along with Appeals Rights and Confidential Names were provided. A Notice of Site Visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. An exit interview was conducted with Director, Jacqueline Serrano.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE: DATE: 08/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2023
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 08/14/2023 05:10 PM - It Cannot Be Edited


Created By: Vicky Williamson On 08/14/2023 at 03:11 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: SKYLINE CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 376700416

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/18/2023
Section Cited
CCR
101223(a)(1)

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101223(a)(1) Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights: (1) To be accorded dignity in his/her personal relationships with staff and other persons. This requirement was not met as evidenced by:
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Director stated Staff 1 (S1) was placed on probation from 3/8/23 to 3/13/23 and resigned on 5/8/23. Director provided proof of personal rights training conducted on 8/11/23 and sign-in sheet.


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Based on interview and record review, the licensee did not comply with the section cited above as the personal rights of children in care were not accorded as Staff (S1) was observed yelling at children which poses a potential health, safety or personal rights risk to persons in care.
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Director stated she will submit a written plan of correction on personal rights to the SDRO no later than 8/18/23.

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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: 08/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2023


LIC809 (FAS) - (06/04)
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