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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370800600
Report Date: 10/26/2021
Date Signed: 10/27/2021 08:18:24 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:TRINITY CHRISTIAN SCHOOL - PRESCHOOLFACILITY NUMBER:
370800600
ADMINISTRATOR:AXE, SHARON & DRUMMOND J.FACILITY TYPE:
850
ADDRESS:3902 KENWOOD DRIVETELEPHONE:
(619) 462-6440
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY:30CENSUS: 0DATE:
10/26/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:05 PM
MET WITH:Jimmie Drummond, LicenseeTIME COMPLETED:
06:45 PM
NARRATIVE
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On 10/26/2021 at 4:05 p.m., Licensing Program Analyst (LPA), Michelle Hood and Licensing Program Manager (LPM), Cynthia Gray arrived to conduct an unannounced case management inspection. During inspection there were no children present.

During a complaint inspection, LPA Hood reviewed 15 children's files. The Physician's Report (medical assessment) - LIC 701 was missing from eleven files. These forms must be completed prior to, or within 30 calendar days following the enrollment of a child, the director shall obtain a written medical assessment of the child.

See LIC 809D for deficiency.

Director was provided appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. Notice of Site Visit (LIC 9213) was provided to be posted at the facility for 30 days. LPA observed form LIC 9213 posted. An exit interview was conducted with director.
SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Michelle HoodTELEPHONE: (691) 767-2241
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021
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: TRINITY CHRISTIAN SCHOOL - PRESCHOOL
FACILITY NUMBER: 370800600
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/26/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/05/2021
Section Cited

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101220 (a) Prior to, or within 30 calendar days following the enrollment of a child, the director shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child. This requirement was not met as evidenced by...

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Based on LPA's file review, 11 out of 15 files did not contain a written medical assessment. The director failed to ensure the LIC 701 were obtained prior to, or within 30 calendar days following the enrollment of a child. This poses an potential Health & Safety risk to the children in care.
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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: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Michelle HoodTELEPHONE: (691) 767-2241
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2021
LIC809 (FAS) - (06/04)
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