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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370806232
Report Date: 06/04/2021
Date Signed: 06/04/2021 11:03:24 AM

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: 31DATE:
06/04/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Karen GarciaTIME COMPLETED:
11:15 AM
NARRATIVE
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On 6/4/21 at 10:30 AM Licensing Program Analysts (LPAs) Adrian Mangina and Keturah Lane conducted an unannounced Case Management Deficiency visit. The purpose of the visit was to cite facility for not reporting unusual incidents that occurred on 4/9/21. During the visit. LPAs met with Director Karen Garcia. The total census observed was 31: classroom 6 had 3 children with staff member Cindy Adams, classroom 4 had 9 children with staff members Stephanie Carr and substitute teacher's aide Mary Caulderon, classroom A had 8 children with staff member Nikkita Kemp, Classroom B had 11 children with staff member Zyntia Acosta. Facility was within ratio and capacity.

During the visit LPAs LPAs requested Unusual Incidents Reports (UIRs) for incidents that occurred on 4/9/21. LPAs observed that no UIRs were submitted for incidents that occurred on 4/9/21 when Child #1 was left in the bathroom alone with no adult supervision and later that same day when Staff #1 was photographed sleeping at a table with no other adult there supervising children. 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)(C Reporting Requirements (refer to LIC809D attached).

An exit interview was conducted with Director and a copy thie report, 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: 06/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2021
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: 06/04/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/08/2021
Section Cited

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101212(d)(1)(C )Reporting Requirements: Upon occurance...any of the events specified... a report shall be made to the Department by telephone or fax...next working day... a written report...within seven days...Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.
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This requirement was not met as evidenced by:
Director admitted that she did not submit incident reports as required for incidents occurring on 4/9/21 when Chilld #1 was left alone in bathroom and Staff #1 was alseep while supervising children at nap time. 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: 06/04/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/04/2021
LIC809 (FAS) - (06/04)
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