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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370806232
Report Date: 03/29/2023
Date Signed: 03/29/2023 01:52:37 PM


Document Has Been Signed on 03/29/2023 01:52 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:
03/29/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Karen GarciaTIME COMPLETED:
02:15 PM
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On 3/29/2023 @ 1:15PM, Licensing Program Analyst (LPA) Nancy Diaz conducted a follow-up inspection to check on the proof of corrections to deficiencies cited on 3/22/23. Observed present today were 25 (napping) children with staff Hannah Fuentes, Zynthia Acosta, Cindy Adams & Kendra Bowen.

The following corrections were observed today:

1. Zynthia Acosta submitted proof that she has been immunized against Measles, however she is missing proof of being immunized against Pertussis. Ms. Acosta will obtain her Pertussis immunization no later than Monday, April 3, 2023.

2. Staff Hannah Fuentes and Claudia Luevanos obtained the required Health Screening. Ms. Luevanos' Health screening form did not have the official Medical Doctor's stamp. Mrs. Garcia will have Ms. Luevanos obtain the doctor's stamp and submit a copy to the department no later than April 3, 2023.

No deficiency cited today.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:
DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/29/2023
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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