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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370806232
Report Date: 05/10/2021
Date Signed: 05/10/2021 01:19:29 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: 36DATE:
05/10/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Karen GarciaTIME COMPLETED:
10:30 AM
NARRATIVE
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On 5/10/21 at 9:40 AM Licensing Program Analysts (LPAs) Adrian Mangina and Keturah Lane conducted an unannounced Case Management regarding deficiencies observed during the visit. LPAs met with Director Karen Garcia. The total census observed was 36: classroom 6 had 4 children with staff member Cindy Adams, classroom 4 had 10 children with staff members Stephanie Carr and substitute teacher Mary Caulderon, classroom A had 11 children with staff member Nikkita Kemp, Classroom B had 11 children with staff member Zyntia Acosta.

LPAs also visited the facility for the purpose of providing an amended report previously provided to Licensee on 4/26/21.

During the visit LPAs toured the facility and reviewed staff records. At 10:00 AM, during review of the staff records LPAs observed that Staff Member #1 was fingerprint cleared but not associated to the facility during the two months working at the facility between 2/23/21 and 4/12/21. Staff #2 was hired on 7/23/2019 and was fingerprint cleared but not associated to the facility until 4/27/21. Pursuant to Title 22 of the CA Code of Regulation, the following Type B deficiency was cited and Title 22 Section 101170(e)(1):Criminal Records Clearance (refer to LIC809D attached0> CIVIL PENALTIES were assessed in the amount of $1000 plus $250 for a repeat violation. Licensee was provided copies of Civil Penalties Assessment LIC421BG and LIC421FC.

An exit interview was conducted with Director and a copy of appeal rights and Notice of Site Visit provided Licensee made aware that Notice of Site visit must be posted for 30 days. LPA observed Licensee post the Notice of Site visit. Signature on this form acknowledges receipt.
SUPERVISOR'S NAME: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Adrian L ManginaTELEPHONE: (619) 767-2209
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2021
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: SAINT DAVID'S PRESCHOOL
FACILITY NUMBER: 370806232
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/10/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/11/2021
Section Cited

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101170(e)(1): Criminal records Clearances Before working or voluntering in a licensed childcare facility, all individuals subject to a criminal record review have clearance or exemption and have been associated to the facility.
The requirement was not met as evidenced by:
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Based on staff records LPA found that Staff #1 had criminal record clearance but was never associated to the facility in the months she worked and Staff #2 was hired 7/23/19 and had criminal record clearances but was not associated to the facility until 4/27/21. This 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: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Adrian L ManginaTELEPHONE: (619) 767-2209
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2021
LIC809 (FAS) - (06/04)
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