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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370800126
Report Date: 05/17/2022
Date Signed: 05/17/2022 05:06:32 PM


Document Has Been Signed on 05/17/2022 05:06 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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108



FACILITY NAME:CHULA VISTA PRESBYTERIAN PRESCHOOLFACILITY NUMBER:
370800126
ADMINISTRATOR:INGRAHAM, ALEXISFACILITY TYPE:
850
ADDRESS:940 HILLTOP DRIVETELEPHONE:
(619) 426-2292
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY:60CENSUS: 31DATE:
05/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:48 AM
MET WITH:Alexis IngramTIME COMPLETED:
04:00 PM
NARRATIVE
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On 5/17/22, at 10:48am, Licensing Program Analyst (LPA), Martha Malane, conducted an unannounced annual inspection and met with Director, Alexis Ingram. LPA disclosed the purpose of the inspection and toured of the facility indoors and outdoors. This is a full day program which operates year-round Monday - Friday 7:30am - 5:00pm. There are currently three (3) classrooms in operation. The following ratios were observed:

Classroom 2: serves children age 2-3 years; there were seven (7) children and one (1) staff
Classroom 3: serves children age 3-4 years; there were 14 children and two (2) staff
Classroom 4: serves children age 4-5 years; there were 10 children and two (2) staff
There were 31 children and five (5) staff present during today’s inspection.

Director stated there are no swimming pools or other bodies of water on the premises. Director stated no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions and other hazardous items are made inaccessible. No poisons were observed. Furniture and equipment are in good condition. Playground equipment is in safe condition. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. Areas around high climbing equipment and slides have sand as cushioning material to absorb falls. Toilets and hand washing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors. Facility has a functioning carbon monoxide detector that met statutory requirements.

At least one person trained in CPR and Pediatric First Aid is present when children are at the facility. The name of the childcare center director was reported to the Department. The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. Children are under supervision, including visual supervision, of a teacher at all times. LPA reviewed a sample of children’s and staff members files. Required postings are posted. See LIC809C continuation...
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha MalaneTELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2022
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 6


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: CHULA VISTA PRESBYTERIAN PRESCHOOL
FACILITY NUMBER: 370800126
VISIT DATE: 05/17/2022
NARRATIVE
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LPA reviewed with director the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records and documents to be posted.

Director was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

This facility provides Incidental Medical Services (IMS). Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm. See LIC809D for deficiencies cited.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiencies are being cited: (see next page, 809 D).

A notice of site visit was given and must remain posted for 30 days from today's date. Exit interview conducted with Alexis Ingram.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha MalaneTELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 05/17/2022 05:06 PM - It Cannot Be Edited

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: CHULA VISTA PRESBYTERIAN PRESCHOOL
FACILITY NUMBER: 370800126

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/17/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101221(a)
Child's Records
(a) The licensee shall ensure that a separate, complete and current record for each child is maintained in the child care center.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview with director and record review, the licensee did not comply with the section cited above in one (1) out of 10 children (C1) did not have a file with completed paperwork for reveiw which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/23/2022
Plan of Correction
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Director stated she will obtain all required paperwork for C1 and submit the paperwork to CCL by 5/23/22. Director stated she will create a file for each child and follow-up with parent or guardian to ensure all chldren enrolled have a file with required paperwork.
Type B
Section Cited
CCR
101226(e)(3)(A)
Health-Related Services
(3) Prescription medications may be administered if all of the following conditions are met: (A) Prescription medications shall be administered in accordance with the label directions as prescribed by the child's physician.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above in one (1) out of one (1) children (C1) did not have a prescription label with directions on medication which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/23/2022
Plan of Correction
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Director stated she will obtain a prescription label with directions for C1's medication by 5/23/22. Director stated she will communicate with parents and staff about the proper care and storage of medication to ensure all medication is in an original package with prescription label.

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 VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha MalaneTELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2022
LIC809 (FAS) - (06/04)
Page: 2 of 6


Document Has Been Signed on 05/17/2022 05:06 PM - It Cannot Be Edited

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: CHULA VISTA PRESBYTERIAN PRESCHOOL
FACILITY NUMBER: 370800126

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/17/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in four (4) out of five (5) staff did not have current mandated reporter certificates on file for review which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/03/2022
Plan of Correction
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Director stated she will submit current mandated reporter training certificates for S1, S2, S3 and S5 to CCL by 6/3/2022. Director stated she will reveiw staff files annually to ensure required paperwork is up to date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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 VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha MalaneTELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2022
LIC809 (FAS) - (06/04)
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