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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372000455
Report Date: 03/06/2020
Date Signed: 03/06/2020 02:47:34 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:PILGRIM DAY CARE CENTERFACILITY NUMBER:
372000455
ADMINISTRATOR:JENNIFER GOINSFACILITY TYPE:
850
ADDRESS:2020 CHESTNUT AVENUETELEPHONE:
(760) 729-4464
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY:110CENSUS: 67DATE:
03/06/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:27 PM
MET WITH:Colleen O'Connor & Terry AnttiTIME COMPLETED:
03:00 PM
NARRATIVE
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LPA Nancy Diaz conducted an unannounced annual site inspection today. LPA met and toured the facility with Colleen O'Connor. Ass't Site Director Terry Antti assisted this analyst in file review. Children were napping in all the classrooms today. All required notices, forms and license were posted in an area visible to the parents or authorized person. The following census were observed today in the following areas:
Outdoor play area with one child and staff Marianne Robson
Blue Room with 7 napping children and staff Leticia Barba
Green Room with 9 napping children and staff Sela Keshka
Yellow Room with 9 napping children and staff Nidia Mendez-Cuevas
Orange Room with 8 napping children and staff Sheila Carpenter & Alejandra
Reynoso-Olmos
Teal Room with 12 napping children and staff Brandi Bolivar
Purple Room with 11 napping children and staff Lakeisha Holley & Farnaz
Dehkarghaniyan

There were no bodies of water observed within the premises. Facility do not maintain weapons on site. All children are under supervision, including visual observation, of a teacher at all times. There is a ratio of one teacher supervising no more than 12 children in attendance. Disinfectants, cleaning solutions, and other items that are dangerous to children are inaccessible via latched cabinets or storage above the counter. Medications are in a safe place inaccessible to children. Furniture and playground equipment are kept in good condition, free of sharp, loose or pointed parts. All toilets and handwashing facilities are safe and working in sanitary conditions. Uncontaminated drinking water is available both indoors and out. Menus are posted at least one week in advance, where an authorized representative can view them.

CONTINUED
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020
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 4
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: PILGRIM DAY CARE CENTER
FACILITY NUMBER: 372000455
VISIT DATE: 03/06/2020
NARRATIVE
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Outdoor activity space surface is maintained in a safe condition and free of hazards. All storage containers for solid waste have a tight-fitting covers that are kept on and in good repair. The areas under high climbing equipment, swings, slides have sufficient cushioning material to absorb falls.
Licensee operates the facility within the conditions, limitations and capacity specified on the license. Staff records contain appropriate documentation of education credits. At least one person trained in CPR and Pediatric First Aid is present. The person who signs the child in/out uses their full legal signature and records the time of day. Child’s admission agreement is available for review. Child is signed in/out by the person responsible for the child.
A handout was provided to the director today on “Effects of Lead Exposure”. Director shall provide a copy of this handout to all the daycare parents.

The following handouts were provided to the Site Director today:

PIN 19-10-CCP (CPSC product recall for Fisher Price Ultra Lite Play Yard
PIN 19-09-CCP (Head Lice Information for Child Care Providers)
PIN 19-08-CCP (CDPH New Pre-K and school immunization requirements
PIN 19-06-CCP (U.S. Consumer Product recall - Infant sleepers)
PIN 19-02-CCP (Safe Sleep Awareness Campaign)
PIN 20-01-CCP (Lead Testing for drinking water)
PIN 19-18.1-CCP (Emergency and Disaster information)
PIN 19-16-CCP (CPSC regarding inclined infant sleep devices)
PIN 19-12-CCP (CPSC Infant sleeper recall)
PIN 20-02 CCP (Coronavirus information and guidelines)
Child Care Providers can now sign up for Quarterly Updates and PINS through the DSS website. Please go to www.ccld.ca.gov and click on Child Care, go under Quick Links and Quarterly updates, click on “Receive Important Updates” then enter your email address and choose which program(s) you would like to subscribe to and click “subscribe”.
TYPE B DEFICIENCIES WERE CITED TODAY. CIVIL PENALTY WAS ALSO ASSESSED. Type B deficiency if not corrected poses a potential risk to the health, safety or personal rights of children in care.
An Exit interview was conducted. Appeal rights were provided in writing.
LPA observed the Representative post the Notice of Site Visit in a prominent place. The Representative states it is understood that this notice must be posted for 30 days.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: PILGRIM DAY CARE CENTER
FACILITY NUMBER: 372000455
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/06/2020
Section Cited

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CRIMINAL RECORD CLEARANCE.
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 101170(f)
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This regulation requirement was not met as evidenced by:
LPA reviewed the fingerprint association list and did not find the following staff associated to the facility: Terry Antti and Farnaz Dehkharghaniyan.
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Type B
03/17/2020
Section Cited

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CCC - H & S Section 1596.7995. Effective September 1, 2016, a person may not be employed or volunteer at a child care center unless he or she has been immunized against influenza, pertussis, and measles.

This requirement was not met as evidenced by:

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LPA reviewed staff files today. Staff Brandi Bolivar & Nidia Mendez Cuevas did not have the required immunization for Pertussis, Measles and Influenza.
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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: 03/06/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2020
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: PILGRIM DAY CARE CENTER
FACILITY NUMBER: 372000455
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/17/2020
Section Cited

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H & S Section 1596.8662 create requirements for mandated child abuse reporter training. Applicants, licensees, and facility employee may meet this requirement free of cost by accessing the online training module provided on the Department of Social Services, Mandated Reporter Training Website: www.mandatedreporterca.com (effective 1/1/2018)

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This requirement was not met as evidenced by:
LPA's review of facility staff files. The following staff did not have a current Mandated Reporter Training certificate on file: Marianne Robson, Brandi Bolivar, Leticia Barba, Sheila Carpenter, Selah Keshka, Nidia Mendez Cuevas & Jennifer Goins.
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Type B
03/17/2020
Section Cited

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PERSONNEL REQUIREMENTS.
All personnel, including the licensee, administrator and volunteers, shall be in good health and shall be physically and mentally capable of performing assigned tasks.
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.
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This requirement was not met as evidenced by: LPA reviewed staff files and found that staff Brandi Bolivar did not have a Physician's report on file.
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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: 03/06/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4