<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370806232
Report Date: 10/18/2023
Date Signed: 10/18/2023 04:54:32 PM


Document Has Been Signed on 10/18/2023 04:54 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: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: 24DATE:
10/18/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Karen GarciaTIME COMPLETED:
05:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 10/18/23 at 4:30 PM Licensing Program Analyst (LPA) Adrian Mangina conducted an unannounced Case Management Deficiency visit. The purpose of the visit was to cite facility for not reporting unusual incident that occurred on 9/22/23. During the visit. LPA met with Director Karen Garcia. The total census observed was 24 children in 4 classrooms and nap room with 5 teachers. Facility was within ratio and capacity.

During the visit LPA interviewed staff who stated that a child protective services report was made regarding child 1. Pursuant to Title 22, Division 12, Chapter 1 of the California Code of Regulation, the following Type B deficiency was cited Section 101212(d)(1)(B) Reporting Requirements (refer to LIC809D attached).

An exit interview was conducted with Director Karen Garcia. Notice of Site was given and must be posted
SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Adrian L ManginaTELEPHONE: (619) 629-6197
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2023
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 2


Document Has Been Signed on 10/18/2023 04:54 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: SAINT DAVID'S PRESCHOOL
FACILITY NUMBER: 370806232

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/20/2023
Section Cited
CCR
101212(d)(1(B)

1
2
3
4
5
6
7
REPORTING REQUIREMENTS: upon the occurrence, a report shall be made to the Department by telephone or fax...next working day...during its normal business hours. In addition, written report... shall be submitted...within seven days following the occurrence...
1
2
3
4
5
6
7
Licensee states will submit incident report no later than close of business 10/20/23 and will review reporting requirements regulation, conduct staff training on incident reporting, and will in future report all unusual incidents timely.
8
9
10
11
12
13
14
Based on interview & record review Licensee did not comply with regulation above as staff failed to report 9/22/23 incident wherein a CPs report was made regarding child 1 and not reported verbally within 24 hours/in writing in 7 days which poses a potential health, safety, or personal rights risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Adrian L ManginaTELEPHONE: (619) 629-6197
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2