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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370806232
Report Date: 10/16/2020
Date Signed: 10/16/2020 01:33:14 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 DAVID'S PRESCHOOLFACILITY NUMBER:
370806232
ADMINISTRATOR:KAREN GARCIAFACILITY TYPE:
850
ADDRESS:5050 MILTON STREETTELEPHONE:
(619) 276-7048
CITY:SAN DIEGOSTATE: CAZIP CODE:
92110
CAPACITY:53CENSUS: 25DATE:
10/16/2020
TYPE OF VISIT:Case Management - DeficienciesANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Karen GarciaTIME COMPLETED:
01:45 PM
NARRATIVE
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On 10/16/2020 at 1:00 PM, Licensing Program Analyst (LPA) Elise Read conducted an announced virtual case management inspection for the purpose of following up on an incident that was reported on 09/25/20. The original follow up was conducted via telephone call on 09/30/2020. LPA met with Director Karen Garcia. Due to COVID-19, this inspection was conducted virtually using Zoom. At the time of inspection, there were 25 children with 6 staff in 3 classrooms.

The incident occurred on 09/25/2020 when Staff #1 (S1) took a group of 9 children to the bathroom. S1 returned with the group to the classroom and was sent on break by S2. Child #1 (C1) entered the classroom approximately 4 minutes later. C1 was upset and stated that they were left alone in the bathroom. S2 informed the Director of the incident. The parents of C1 were informed and Director met with S1 and S2.

The Department reviewed the incident. It was determined that citations were needed in response to this incident due to the lack of supervision.
Director stated that since the incident, she has created a new form called the "Break Documentation and Count" form that is used between staff to document their break time, who is giving them their break, and how many children they have at that time. Director has also updated the staff handbook to include more specific expectations on supervision and child counts. She has created "count minimums" for her staff that include the minimum times and places they should be counting their children. She conducted a staff meeting on 10/15/20 where she reviewed the updates to the staff handbook with all of her staff and has conducted ongoing check in meetings with S1, who was involved in the incident.

Please see LIC 809D for cited deficiencies.

An exit interview was conducted with the Director. Director will receive a copy of their appeal rights, this report, and a Notice of Site Visit via email. Director will reply to the email confirming receipt of these documents. Notice of Site Visit will remain posted for 30 days.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Elise ReadTELEPHONE: (619) 767-2240
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2020
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: SAINT DAVID'S PRESCHOOL
FACILITY NUMBER: 370806232
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/23/2020
Section Cited

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Responsibility for Providing Care and Supervision- No child(ren) shall be left without the supervision of a teacher at any time…Supervision shall include visual observation. This requirement was not met as evidenced by:
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Based on record review and interview with Director, licensee did not ensure that C1 was supervised by a teacher during the bathroom break on 09/25/20, which poses a potential Health, Safety, or Personal Rights risk to children in care.
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has conducted ongoing meetings with the staff involved in the incident, S1. Director will submit the updated form, handbook, staff meeting agenda and sign in, as well as the "Staff Support Plan" that she is using with S2 via email to LPA Read by 10/23/2020.

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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: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Elise ReadTELEPHONE: (619) 767-2240
LICENSING EVALUATOR SIGNATURE:
DATE: 10/16/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2020
LIC809 (FAS) - (06/04)
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