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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370801689
Report Date: 09/21/2022
Date Signed: 09/21/2022 11:01:08 AM


Document Has Been Signed on 09/21/2022 11:01 AM - 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:ST. JAMES LUTHERAN PRESCHOOL & CHILD CARE CENTERFACILITY NUMBER:
370801689
ADMINISTRATOR:MENDEZ, LINDAFACILITY TYPE:
850
ADDRESS:866 IMPERIAL BEACH BOULEVARDTELEPHONE:
(619) 423-8648
CITY:IMPERIAL BEACHSTATE: CAZIP CODE:
91932
CAPACITY:66CENSUS: 8DATE:
09/21/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Kristina Barraza-SantillanTIME COMPLETED:
11:15 AM
NARRATIVE
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On 09/21/22 at 10:15 AM, LPA Luigi Gargaro conducted an unannounced case management visit to the facility to deliver a reporting requirement violation to the child care center.

In the course of investigating a complaint against the facility, it was determined that the licensee did not report an injury incident to the Child Care Licensing Program as required by the Department.

An exit interview was conducted and the report was reviewed with facility director Kristina Barraza-Santillan. A copy of this report, along with Appeal Rights (LIC9058 01/16), were provided. A notice of site visit was given and must remain posted for 30 days. LPA observed that the notice of site visit was posted during the inspection. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi GargaroTELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2022
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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Document Has Been Signed on 09/21/2022 11:01 AM - 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: ST. JAMES LUTHERAN PRESCHOOL & CHILD CARE CENTER
FACILITY NUMBER: 370801689

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/28/2022
Section Cited

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101212(d)(1)(E) Reporting Requirements – Upon the occurrence…of any of the events…below, a report shall be made to the Department…by telephone or fax within the Department's next working day...In addition, a written report…shall be submitted to the Department within seven days...(1) Events reported shall include the following: (B) Any injury to any child that requires medical treatment.This requirement was not met as evidenced by:
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Based on LPA’s records review and interview with the facility director, the licensee did not report a child injury in a facility classroom that required medical treatment to the Department, which poses a potential health and safety risk to 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: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi GargaroTELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2022
LIC809 (FAS) - (06/04)
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