372000465-5-16-2022-20-CC-MMAE-CEH4WH-20220516192759

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 372000465
Report Date: 05/16/2022
Date Signed: 05/16/2022 07:28:09 PM

Document Has Been Signed on 05/16/2022 07:28 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:	POINT LOMA COMMUNITY CHURCH PRESCHOOL		FACILITY NUMBER:	372000465
ADMINISTRATOR:	NICOLE HAGE		FACILITY TYPE:	850
ADDRESS:	2128 CHATSWORTH BOULEVARD		TELEPHONE:	(619) 223-3327
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92107
CAPACITY:	120	CENSUS: 90	DATE:	05/16/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:48 AM
MET WITH:	Nicole Hage		TIME COMPLETED:	05:15 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 5/16/22, at 10:48am, Licensing Program Analyst (LPA), Martha Malane, conducted an unannounced annual inspection and met with Director, Nicole Hage and Assistant Director Andrea Benitez.. LPA disclosed the purpose of the inspection and was led on a tour of the facility indoors and outdoors. This is a full day program which operates year-round from 8:00am - 5:00pm. There are eight (8) classrooms in operation. The following ratios were observed: Classroom 1: serves children age 3-4 years; there were 13 children and two (2) staff Classroom 2: serves children age 3-4 years; there were 14 children and two (2) staff Classroom 3: serves children age 4-5 years; there were 13 children and two (2) staff Classroom 4: serves children age 4-5 years; there were 14 children and two (2) staff Classroom 5: serves children age 3-4 years; there were eight (8) children and two (2) staff Classroom TLC 1: serves children age 2-3 years; there were nine (9) children and two (2) staff Classroom TLC 2 serves children age 2-3 years; there were nine (9) children and two (2) staff Classroom TLC 3: serves children age 2-3 years; there were 10 children and two (2) staff There were 90 children and 16 staff present during today’s inspection. Director stated there is no swimming pool or other bodies of water on the premises. Director stated 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. 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 around high climbing equipment and slides have cushioning material to absorb falls. 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. 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: 05/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2022

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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Document Has Been Signed on 05/16/2022 07:28 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: POINT LOMA COMMUNITY CHURCH PRESCHOOL	FACILITY NUMBER: 372000465
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/16/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101226(e)(3)(A)

Health-Related Services

(3) Prescription medications may be administered if all of the following conditions are met: (A) Prescription medications shall be administered in accordance with the label directions as prescribed by the child's physician. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above in two (2) out of five (5) prescription medications were not in the original packaging with label instructions which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/20/2022
	Plan of Correction
1 2 3 4	Director stated she will train all staff in the proper care and storage of medication to ensure all medication has prescription label instructions. Director will send proof of medication in original packaging to CCL by 5/20/22.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha Malane	TELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2022

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: POINT LOMA COMMUNITY CHURCH PRESCHOOL	FACILITY NUMBER: 372000465
	VISIT DATE: 05/16/2022

NARRATIVE

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At least one person trained in CPR and Pediatric First Aid is present when children are at the facility. The name of the childcare center director was reported to the Department. The person who signs the child in/out of the facility shall use their full legal signature and records the time of day (facility utilizes Brightwheel application for sign in/out). Children are under supervision, including visual supervision, of a teacher at all times. LPA reviewed a sample of children’s and staff members files. Required postings are posted.

LPA reviewed with director the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records and documents to be posted.

Director was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

This facility provides Incidental Medical Services (IMS). 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. See LIC809D for deficiencies cited.

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/inspection-process.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiency is being cited: (see next page, LIC809 D).

A notice of site visit was given and must remain posted for 30 days from today's date. Exit interview conducted with Nicole Hage.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha Malane	TELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2022

LIC809 (FAS) - (06/04)

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