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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370806227
Report Date: 11/14/2019
Date Signed: 11/14/2019 03:57:54 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:SAINT MICHAEL PRESCHOOLFACILITY NUMBER:
370806227
ADMINISTRATOR:VERONICA DAYAGFACILITY TYPE:
850
ADDRESS:2637 HOMEDALE STREETTELEPHONE:
(619) 472-5437
CITY:SAN DIEGOSTATE: CAZIP CODE:
92139
CAPACITY:45CENSUS: 23DATE:
11/14/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Maria MendozaTIME COMPLETED:
04:20 PM
NARRATIVE
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Licensing Program Analysts (LPAs), Rajani Goudreau and Martha Malane made an unannounced annual/random inspection. Upon arrival, LPAs met with acting Director, Maria Mendoza and proceeded to tour the facility. Director, Veronica Dayag is currently out today. There were 23 children in care with four staff members. The facility is within licensed capacity/ratio limitations. Program operates Monday through Friday from 6:00 a.m. to 6:00 p.m.

LPAs toured the facility. The furniture, toys, books, games and play equipment, both inside and out, are safe, age-appropriate and in good repair. All rooms have adequate heating, lighting and ventilation, are clean and orderly, and are free of hazards. Bathrooms and hand washing areas are in a safe, sanitary and operating condition. The facility provides Am and PM snack. Children bring lunch from home. Facility has a mini kitchen, located in the 2 year old classroom. No expired food items were noted. Menus were posted and are being stored for a minimum of 30 days. All hazardous items are stored where they are inaccessible to children. The outdoor play area is fenced, has adequate shade and has sufficient cushioning under and around play structure. LPA reminded acting Director to ensure water tables are emptied after each use. There is no evidence of rodent or insect activity. Several staff present have a current CPR and First Aid certification. Sign in/out sheets were reviewed. LPA reminded acting Director, children must be signed in and out of the facility by the person responsible for the children. LPAs observed appropriate supervision in and out of the classroom. A sample of children's records were reviewed for admission’s agreements and staff records for qualifications. Facility has not conducted a disaster drill for the year of 2019, based on file review and staff admission. LPA informed acting Director requirements and times frames for conducting disaster drills. Acting Director, acknowledges understanding of requirement. LPA discussed SB 792 (staff immunization's) and AB 1207 (Mandated Reporter Training) requirements. Effects of Lead Exposure Handout provided for the facility to disseminate to the parents/guardians of currently and newly enrolled children. See LIC809-C continuation page...
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Rajani GoudreauTELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2019
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: SAINT MICHAEL PRESCHOOL
FACILITY NUMBER: 370806227
VISIT DATE: 11/14/2019
NARRATIVE
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During review of medications, one epinephrine injector did not have labeled instructions from a Physician and medication did not have its original packing. LPA informed acting Director of the requirements for IMS medications.

This facility provides Incidental Medical Services - IMS. IMS plan on file and approved by the Department. LPA reviewed storage of medication and equipment/supplies, and reviewed children, 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. Services are in place.

LPAs discussed and provided Director with the following: Child Care Advocates - (916) 654-1541 and email address childcareadvocatesprogram@dss.ca.gov.In addition, for common questions or questions regarding licensing requirements to contact the Child Care Licensing duty line at 619-767-2248. Community Care Licensing WEB SITE: http://www.ccld.ca.gov/


LPAs informed Director to provide the following to Licensing no later than 12/31/19:
  • Provide an updated LIC 999: Facility Sketch reflecting floor plan of classrooms
  • Current board minutes reflecting board members and acting board member for the preschool along with board member signatures

Facility was two type B violations during today’s visit (see same day 809D citations page). An exit interview was conducted. A copy of this report along with LIC809-D and appeal rights (LIC 9058) were left at facility. Analyst printed a copy of the Notice of Site Visit today. Facility shall post the notice of site visit for 30 days from today’s date (observed by LPA). Director signature on this form acknowledges receipt of these rights.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Rajani GoudreauTELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2019
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: SAINT MICHAEL PRESCHOOL
FACILITY NUMBER: 370806227
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/22/2019
Section Cited

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101174 -Disaster and Mass Casualty Plan. (d)-Disaster drills shall be conducted at least every six months. This requirement was not met as evidenced by:
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based on file review and staff admission, facility has not conducted a disaster drill for the year of 2019, which poses a potential health and safety risk to children in care.
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Type B
11/22/2019
Section Cited

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101226- Health-Related Services. ( e) -In centers where the licensee chooses to handle medications:(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 was not met as evidenced by:
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 during review of medications, one epinephrine injector did not have labeled instructions from a Physician and medication did not have its original packing, which poses a potential health and safety risk to children in care.

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LPA and acting Director developed the following plan of correction: facility will provide a plan of operation to ensure storage requirements for medications are met and provide to the Department by 11/22/19.
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: Rajani GoudreauTELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:
DATE: 11/14/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/14/2019
LIC809 (FAS) - (06/04)
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