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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 136608040
Report Date: 06/12/2019
Date Signed: 06/12/2019 09:34:54 AM

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:ICOE-CDS LITTLE KING'S STATE PRESCHOOLFACILITY NUMBER:
136608040
ADMINISTRATOR:KARINA CHAVEZFACILITY TYPE:
850
ADDRESS:1950 VILLA AVENUETELEPHONE:
(760) 482-0790
CITY:EL CENTROSTATE: CAZIP CODE:
92243
CAPACITY:30CENSUS: 14DATE:
06/12/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Matilde MontesTIME COMPLETED:
09:40 AM
NARRATIVE
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LPA Nancy Diaz conducted an unannounced annual site inspection today. LPA met with site director Matilde Montes. A tour of the facility was conducted by the LPA (inside and outside). All required notices, forms and license were posted in an area visible to the parents or authorized person. There were 14 children present today, supervised by Matilde Montes and substitute Adriana Guizar.

There were no bodies of water or weapons maintained on site. All children are under supervision, including visual observation, of a teacher at all times. Appropriate staff-children ratio was maintained today. Disinfectants, cleaning solutions and other items that are dangerous to children are inaccessible via storage in the latched kitchen cabinet. Furniture and playground equipment are kept in good condition, free of sharp, loose or pointed parts. All toilets and handwashing facilities are safe and working in sanitary conditions. Uncontaminated drinking water is available both indoors and out. Menus are posted at least one week in advance, where an authorized representative can view them.

All storage containers for solid waste have a tight-fitting covers that are kept on and in good repair. The areas under high climbing equipment, swings, slides have sufficient cushioning material to absorb falls.

Licensee operates the facility within the conditions, limitations and capacity specified on the license. Staff records contain appropriate documentation of education credits. Both staff are certified in CPR and Pediatric First Aid. The person who signs the child in/out uses their full legal signature and records the time of day. Child’s admission agreement is available for review. Child is signed in/out by the person responsible for the child. A copy of "Effects of Lead Exposure" has been provided to parents of children.

CONTINUED ON PAGES 2 & 3
SUPERVISOR'S NAME: Carolina RamosTELEPHONE: (619) 767-2206
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2019
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: ICOE-CDS LITTLE KING'S STATE PRESCHOOL
FACILITY NUMBER: 136608040
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/30/2019
Section Cited
CCR
101238.2(d)(2)
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Outdoor activity space shall be free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard.
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Mrs. Montes will notify her supervisor regarding the condition of the outdoor play surface. She will submit a plan of action to the department no later than 6/30/2019.
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This regulation requirement was not met as evidenced by LPA's observation. There were holes and cracks observed on the outdoor surface that poses a tripping hazzard to children at play.
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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: Carolina RamosTELEPHONE: (619) 767-2206
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: ICOE-CDS LITTLE KING'S STATE PRESCHOOL
FACILITY NUMBER: 136608040
VISIT DATE: 06/12/2019
NARRATIVE
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Staff have obtained the required caregiver background checks/criminal record and child abuse index clearances via the Imperial County Office of Education.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Mrs. Montes provided the analyst the following forms: LIC 308 (designation of administrative responsibility); LIC 500 (Personnel Report) and LIC 610 (Emergency Disaster Plan).

TYPE B DEFICIENCY WAS CITED TODAY. Type B violation if not corrected, could become a risk to the health, safety, or personal rights of children in care.


LPA observed the Representative post the Notice of Site Visit in a prominent place. The Representative states it is understood that this notice must be posted for 30 days.
SUPERVISOR'S NAME: Carolina RamosTELEPHONE: (619) 767-2206
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3