370806462-3-21-2023-20-CC-MMAE-CQ24ZU-20230317193319

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 370806462
Report Date: 03/17/2023
Date Signed: 03/21/2023 01:07:04 PM

Document Has Been Signed on 03/21/2023 01:07 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:	POTRERO ELEMENTARY STATE PRESCHOOL CENTER		FACILITY NUMBER:	370806462
ADMINISTRATOR:	CRYSTAL KREMENSKY		FACILITY TYPE:	850
ADDRESS:	24875 POTRERO VALLEY ROAD		TELEPHONE:	(619) 473-9022
CITY:	POTRERO	STATE: CA	ZIP CODE:	91963
CAPACITY:	23	CENSUS: 14	DATE:	03/17/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:24 AM
MET WITH:	Alexa Reynoso		TIME COMPLETED:	12:00 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 3/17/23, at 9:24am, Licensing Program Analyst (LPA) Martha Malane, conducted an unannounced annual inspection and met with Director, Alexa Reynoso. LPA disclosed the purpose of the inspection and was led on a tour of the facility. This is a half day program which operates on a traditional school year schedule. Days and hours of operation are Monday – Friday 9:00am – 12:30pm. There were 14 children and three (3) staff members present. Program Director, Krystal Kremensy arrived at the facility at 10:45am. Director stated there are no bodies of water on the premises. Director stated there are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. No poisons were observed during the inspection. Furniture and equipment are in good condition. Playground equipment is in safe condition. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. Areas under high climbing equipment and slides have rubber chips and sand for cushioning. Toilets and hand-washing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors. Facility has a functioning carbon monoxide detector that met statutory requirements. Meals and snacks are provided by the school district. Director stated all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions through the Mountain Empire Unified School District. Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. See LIC809C continuation...

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha Malane	TELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2023

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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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: POTRERO ELEMENTARY STATE PRESCHOOL CENTER	FACILITY NUMBER: 370806462
	VISIT DATE: 03/17/2023

NARRATIVE

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Capacity and limitations as specified on the license are being maintained. At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at off-site activities. The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. Children are under supervision, including visual supervision, of a teacher at all times. Facility maintains a ratio of one teacher supervising no more than eight (8) children in care. LPA reviewed a sample of children’s files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child and medical assessment.

This facility provides Incidental Medical Services (IMS). All medication is stored and administered by the nurse in the school office. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA and Director discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, Mandated Reporter Training, California Megan’s Law (www.meganslaw.ca.gov), Forms and Regulations.

Director will submit an updated, LIC610, LIC500 and LIC308 to the San Diego Regional Office.

No deficiencies cited during today’s inspection. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Director, Alexa Reynoso.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha Malane	TELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2023

LIC809 (FAS) - (06/04)

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