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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 136608068
Report Date: 05/21/2019
Date Signed: 05/21/2019 12:25:18 PM

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:NOAH'S ARK PRESCHOOL-DAYCAREFACILITY NUMBER:
136608068
ADMINISTRATOR:ANGELICA DRYEFACILITY TYPE:
850
ADDRESS:722 E 6TH STTELEPHONE:
(760) 356-2568
CITY:HOLTVILLESTATE: CAZIP CODE:
92250
CAPACITY:30CENSUS: 25DATE:
05/21/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Libey MartinezTIME COMPLETED:
12:45 PM
NARRATIVE
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LPA Nancy Diaz conducted an unannounced random site inspection today. LPA met with Site Director Libey Martinez. A tour of the facility was conducted. All required notices, forms and license were posted in an area visible to the parents or authorized person. There were 25 children observed present today with staff Libey Martinez, Diana Casanova, Lynne Ming and Christina Tanori. Children-staff ratio were maintained during the inspection.

There were no bodies of water or weapons maintained within the premises. Disinfectants, cleaning solutions, medications and other similar items are inaccessible to children via 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 condition. All floors are kept clean and safe. Kitchen, food preparation and storage areas are kept clean, free of litter, rubbish or rodents and other vermin.

The surface of the outdoor activity space are maintained in a safe condition and free of hazards. All storage containers for solid waste have a tight-fitting covers that are kept on and in good repair. Uncontaminated drinking water are readily available both indoors and outdoor. The areas under high climbing equipment, swings, slides are cushioned with materials that absorbs a fall. Outdoor activity space surfaces are free of hazards.


At least one person trained in CPR and Pediatric First Aid is present. Facility maintains current children’s record including emergency phone numbers of authorized representatives and medical assessment. Personnel record maintained on all staff including health screening. 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: 05/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019
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 5
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: NOAH'S ARK PRESCHOOL-DAYCARE
FACILITY NUMBER: 136608068
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/31/2019
Section Cited
CCR
101215.1(h)(1)(B)
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Twelve of the 15 units required in (h)(1) above shall include courses that cover the general areas of child growth and development, or human growth and development; child, family and community, or child and family; and program/curriculum.
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Site Director shall obtain copy of transcript to show that she completed Child Family & Community class. Copy of transcript shall be submitted to the department no later than 5/31/2019.
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This regulation was not met as evidenced by LPA's review of staff files. Site Director Libey Martinez is missing proof of Child, Family & Community class completion.
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Type B
05/31/2019
Section Cited
HSC
1596.866
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A certificate of completion of a course or courses in preventive health practices as defined in subdivision (a) or certified copies of transcripts that identify the number of hours and the specific course or courses taken for training in preventative health practices as defined in subdivision (a).
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CORRECTED TODAY.
Ms. Libbey provided this LPA a copy of her transcript to show that Health & Safety class was completed.
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This requirement was not met as evidenced by LPA's review of staff files. Site Director Libey Martinez does not have proof of the 8-hour Preventative Health Practices course completion.
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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: 05/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: NOAH'S ARK PRESCHOOL-DAYCARE
FACILITY NUMBER: 136608068
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/31/2019
Section Cited
CCR
101226(e)(2)
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HEALTH RELATED SERVICES.
All prescription and nonprescription medications shall be maintained with the child's name and shall be dated.
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Site Director shall obtain the child's original prescription box with the child's name and date no later than 5/31/2019. Site Director shall submit a photo via email to Nancy.Diaz@dss.ca.gov
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This regulation was not met as evidenced by LPA's observation. A child's medication did not have the original prescription box with the name and date.
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Type B
05/31/2019
Section Cited
HSC
1596.7995
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H & S Section 1596.7995. Effective September 1, 2016, a person may not be employed or volunteer at a child care center unless he or she has been immunized against influenza, pertussis, and measles.
This regulation was not met as evidenced by LPA's review of staff file. Staff Diana Casanova is missing proof of being immunizaed against Pertussis, Measles & Influenza.
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Site Director shall obtain Ms. Casanova's immunization record and submit copy to the department no later than 5/31/2019.
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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: 05/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: NOAH'S ARK PRESCHOOL-DAYCARE
FACILITY NUMBER: 136608068
VISIT DATE: 05/21/2019
NARRATIVE
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The licensee has not exceeded the conditions, limitations and capacity specified on the license.

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.


This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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.

Ms. Martinez provided the LPA with updated forms regarding her designation as site director.

LPA provided Ms. Martinez a handout on IMS (Incidental Medical Services) Plan of Operation. Ms. Martinez shall submit the IMS Plan of Operation to the department no later than 5/31/2019.

TYPE B DEFICIENCIES WERE 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: 05/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: NOAH'S ARK PRESCHOOL-DAYCARE
FACILITY NUMBER: 136608068
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/31/2019
Section Cited
HSC
1596.8662
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This Health & Safety Section create requirements for mandated child abuse reporter training. Applicants, licensees, and facility employee may meet this requirement free of cost by accessing the online training module provided on the Department of Social Services, Mandated Reporter Training Website: www.mandatedreporterca.com
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Site Director shall ensure that Diana Casanova & Christina Tanori complete the training no later than 5/31/2019. Copy of certificate shall be submitted to the department no later than 5/31/2019.
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This requirement was not met as evidenced by LPA's review of staff files. Staff Diana Casanova & Christina Tanori are missing proof of training for Mandated Reporter .
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Type B
05/31/2019
Section Cited
CCR
10215.1(h)(1)(A)
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Three of the 15 units required in (h)(1) above shall be in administration or staff relations.
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Ms. Martinez shall obtain proof of Administration class completion and submit a copy to the department no later than 5/31/2019.
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This requirement was not met as evidened by LPA's review of staff files. Site Director Libey Martinez is missing proof of Administration class completion
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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: 05/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5