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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372005101
Report Date: 12/09/2021
Date Signed: 12/09/2021 04:55:03 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:CARMEL MOUNTAIN PRESCHOOLFACILITY NUMBER:
372005101
ADMINISTRATOR:DONNA TACONIFACILITY TYPE:
850
ADDRESS:9510 CARMEL MOUNTAIN ROADTELEPHONE:
(858) 484-4877
CITY:SAN DIEGOSTATE: CAZIP CODE:
92129
CAPACITY:249CENSUS: 117DATE:
12/09/2021
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Donna TaconiTIME COMPLETED:
05:00 PM
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On 12/09/2021 at 4:00 PM, Licensing Program Analysts (LPAs), Selina Siao and Samantha Clenista conducted a case management visit to follow up on a concern regarding the facility failure to follow mask mandates.

Analysts conducted a tour of the facility and toured all the classrooms. LPAs observed a total of 117 children in care today. There were a total of 97 children inside the classrooms with 48 children unmask. Facility has a total of five two year old classrooms including 6A, 6B, 6C, 2A and 3B. Director stated that the reason that the children are not wearing a mask it is because their parents had signed a mask exemption form. A copy of the mask exemption form that was created by the facility was obtained. Facility shall provide a list of the children with medical exemption along with the medical exemption documents provided by their doctor. A follow up visit will be required by Analyst.

Facility was provided with the latest Provider Information Notice (PIN 21-29-CCP) regarding face covering requirements and guidance for child care providers regarding COVID-19. The PIN is also available on the department's website at: https://www.cdss.ca.gov/Portals/9/CCLD/PINs/2021/CCP/PIN-21-29-CCP.pdf

Facility is within staffing ratios during the tour.

An exit interview was conducted, and appeal rights were provided. A notice of site visit was provided and to be posted at the facility for 30 days. Failure to keep notice posted will result in a civil penalty of $100.00.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021
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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