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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 136608041
Report Date: 05/22/2019
Date Signed: 05/22/2019 10:32:56 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 TIGER'S STATE PRESCHOOLFACILITY NUMBER:
136608041
ADMINISTRATOR:UTE ELIZABETH CERVANTESFACILITY TYPE:
850
ADDRESS:303 SOUTH D STREETTELEPHONE:
(760) 355-8640
CITY:IMPERIALSTATE: CAZIP CODE:
92251
CAPACITY:30CENSUS: 22DATE:
05/22/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Elizabeth CervantesTIME COMPLETED:
10:40 AM
NARRATIVE
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LPA Nancy Diaz conducted an unannounced annual site inspection today. LPA met and toured the facility with Site Director, Elizabeth Cervantes. All required notices, forms and license were posted in an area visible to the parents or authorized person. There were 22 preschool children observed with staff Paola Trancoso, Janine Coronado and Elizabeth Cervantes.

There were no bodies of water observed within the premises. Firearms/weapons are not allowed or stored on premises. All children are under supervision, including visual observation, of a teacher at all times. Appropriate staff-children ratio were maintained. Disinfectants, cleaning solutions and other items that are dangerous to children are inaccessible via storage in locked cabinets. 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. At least one person trained in CPR and Pediatric First Aid is present. 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 handout was provided to the director today on “Effects of Lead Exposure”. Director shall provide a copy of this handout to all the daycare parents.

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: 05/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 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 TIGER'S STATE PRESCHOOL
FACILITY NUMBER: 136608041
VISIT DATE: 05/22/2019
NARRATIVE
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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

A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances.



Mrs. Cervantes provided the analyst copies of updated LIC 500 (Personnel Report) and LIC 610 (Emergency Disaster Plan).

Type B deficiency was cited. 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: 05/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
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 TIGER'S STATE PRESCHOOL
FACILITY NUMBER: 136608041
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/11/2019
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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Site director shall ensure that the outdoor surface be repaired no later than 6/11/2019. Proof of correction shall be submitted via photos emailed to the LPA at Nancy.Diaz@dss.ca.gov
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This regulation requirement was not met as evidenced by LPA's observation. The holes observed on the outdoor surface 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: 05/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3