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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370806232
Report Date: 03/22/2023
Date Signed: 03/22/2023 02:49:56 PM


Document Has Been Signed on 03/22/2023 02:49 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: 25DATE:
03/22/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Karen GarciaTIME COMPLETED:
03:00 PM
NARRATIVE
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On 3/22/23 @ 2:15PM Licensing Program Analyst (LPA), Nancy Diaz conducted an unannounced inspection. The purpose of this inspection is to observe corrections to deficiencies cited on 2/15/2023. A tour of the facility was conducted with Karen Garcia, Site Director. Observed present today were 25 children who were napping (or involved in a quiet activity) in Rooms A & C - Room A with 12 children and staff Zynthia Acosta & Jaime Moyer and Room C with 13 children and staff Cindy Adams Kelly & Tyler McClure-Kent.

The following correction was reviewed and cleared today:

1. A lead study was completed on 3/8/23. Email was provided by Ms. Garcia indicating that the result of the lead study is expected to be completed in 2-3 months.

The following updated forms were provided today:
1. LIC 500 - Personnel Report
2. LIC 610 - Emergency Disaster Plan
3. LIC 9040 - Childrens' Roster

Exit interview conducted and report was reviewed with facility representative, Karen Garcia. A copy of this report, along with Appeal Rights (LIC9058), were provided. A notice of site visit was given and must remain posted for 30 days. LPA observed that the notice of site visit was posted during the inspection. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Type B Deficiencies were cited today.

Mrs. Garcia was reminded that failure to provide corrections by due date may result to civil penalty assessments.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2023
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 03/22/2023 02:49 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: 03/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/27/2023
Section Cited

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Commencing Sept. 1, 2016, a person shall not be employed or volunteer...if she has not been immunized against influenza, pertussis & measles.

This requirement was not met as evidence by:
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REPEAT VIOLATION. Mrs. Garcia stated that she will have staff Zynthia Acosta obtain her immunization record and will submit by 3/27/2023.
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Based on record review and Mrs. Garcia's statement, staff failed to provide a copy of her immunization as previously requested on 2/15/23.
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Type B
03/27/2023
Section Cited

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...A good physical health shall be verified by a health screening...performed by or under the supervision of a physician...no more than one year prior to or 7 days after employment...

This requirement was not met as evidenced by:
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REPEAT VIOLATION. Mrs. Garcia stated that she will have staff Hannah Aceves & Claudia Laevanos obtain Health screening and submit to the department no later than 3/27/2023.
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Based on record review and statement by Mrs. Garcia, staff Hannah Aceves & Claudia Laevanos failed to obtain a health screening as previously requested on 2/15/23.
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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: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2