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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701117
Report Date: 02/18/2025
Date Signed: 02/18/2025 04:00:19 PM

Document Has Been Signed on 02/18/2025 04:00 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:EPISCOPAL COMMUNITY SERVICES - BOYS & GIRLS CLUBFACILITY NUMBER:
376701117
ADMINISTRATOR/
DIRECTOR:		DENISE TREJOFACILITY TYPE:
850
ADDRESS:1430 D AVENUETELEPHONE:
(619) 292-2550
CITY:NATIONAL CITYSTATE: CAZIP CODE:
91950
CAPACITY: 45TOTAL ENROLLED CHILDREN: 40CENSUS: 28DATE:
02/18/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Dulce PerdomoTIME VISIT/
INSPECTION COMPLETED:
11:40 AM
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On 2/18/2025, at 8:40 am., Licensing Program Analysts (LPAs) Vicky Williamson and Oscar Picazo conducted an unannounced case management inspection to follow up on three (3) separate self reported incidents. LPAs met with Site Supervisor, Dulce Perdomo. LPA discussed the purpose of the inspection and was led on a tour of the facility indoor and outdoor. At 9:30am, Area Supervisor, Cecilia Evans Hernandez arrived to the facility. There were 28 children present with six (6) staff members.

On 12/18/2024, the Site Supervisor reported an incident involving a possible personal rights violation regarding Child #1 (C1) being taken to the bathroom by Staff #1 (S1) as a form of discipline. Per Site Supervisor, the alleged incident occurred on 12/17/2024 at about 8:36am.

Interviews were conducted with the site supervisor, staff, daycare children and authorized representative for C1. C1 was not available for interview and is no longer enrolled at the facility. LPA obtained a copy of facility roster, sign in/ sign out sheets and video footage.


On 12/18/2024, Site Supervisor reported an incident regarding a possible lack of supervision involving Child #2 (C2) sustaining an injury to the forehead that required medical attention. Per Site Supervisor, the alleged incident occurred on 12/12/2024, at about 9:25am on the playground.

Interviews were conducted with the site supervisor, staff, and daycare children, including C2. LPA obtained a copy of facility roster and sign in/ sign out sheets. LPAs inspected the play structure determine that it is safe and age appropriate.

Site Supervisor reported that there were two teachers and 15 children on the playground during the time of the incident. Staff #1 (S1) stated that C2 was observed running up the stairs on the play structure. C2 tripped on the steps of the play structure bumping forehead on the steps of the play structure.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2025
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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: EPISCOPAL COMMUNITY SERVICES - BOYS & GIRLS CLUB
FACILITY NUMBER: 376701117
VISIT DATE: 02/18/2025
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Site Supervisor stated that C2’s authorized representative was contacted immediately and the child was picked up. S1 stated that she was positioned on the playground next to the steps leading to the play structure during the time of the incident; however she was unable to break C2’s fall. Staff #2 (S2) stated that she was on the playground during the time of the incident; however she did not observe the incident. S2 stated that she was sitting at the picnic table on the playground completing an activity with a group of five (5) children.

Based on staff and daycare children interviews it was determined that the play structure is age appropriate and there was appropriate staff supervision on the playground during the time of the incident. The incident is determined to be an accident.

On 11/15/2024, the Site Supervisor reported an incident involving a possible personal rights violation regarding Child #3 (C3) being inappropriately mishandled by Staff #3 (S3). Per Site Supervisor, it was alleged that the incident occurred on 11/8/2024, between 9:00am and 11:00am during an interaction outside of the classroom.

Interviews were conducted with the site supervisor, staff, and daycare children. C3 was not available for interview and is no longer enrolled at the facility. LPA obtained a copy of facility roster, sign in/ sign out sheets, and related documentation.

Site Supervisor stated that C3 reported that they were hit on the cheek by S3. S3 denied hitting or handling C3 or any daycare children inappropriately. Staff #1 (S1) stated that she was present on the day in question; however stated she did not observe C3 being inappropriately mishandled by any staff.

No deficiencies cited during today's inspection. A Notice of Site Visit (LIC 9213) was given to Site Supervisor, Dulce Perdomo and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Appeal Rights (LIC 9058) was provided. Exit interview conducted and report was reviewed with Site Supervisor, Dulce Perdomo and Cecilia Evans Hernandez.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2025
LIC809 (FAS) - (06/04)
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