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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372005946
Report Date: 12/16/2019
Date Signed: 02/27/2020 05:46:44 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:ST. COLUMBA PRESCHOOLFACILITY NUMBER:
372005946
ADMINISTRATOR:PATRICIA GILSDORFFACILITY TYPE:
850
ADDRESS:3365 GLENCOLUM DRIVETELEPHONE:
(858) 279-0161
CITY:SAN DIEGOSTATE: CAZIP CODE:
92123
CAPACITY:60CENSUS: 46DATE:
12/16/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:31 PM
MET WITH:Lori Jiannuzzi/DirectorTIME COMPLETED:
03:25 PM
NARRATIVE
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Licensing Program Analyst (LPA) Selina Siao conducted an unannounced case management inspection today. Upon arrival, LPA met with current Director Lori Jiannuzzi and conducted a head count of the children in care. Appropriate ratio were observed during the inspection.

The following ratios were observed: 29 children were walking to church to practice the school performance and were supervised by teacher Fiona Bloemker, Holy Margaret Nguyen and Director Lori Jiannuzzi. There were 17 children at the playground supervised by teachers Rosa Salazar and substitute teacher Miriam Andrade. Staff members Holy Margaret Nguyen and substitute teacher's fingerprint clearances but they are not associated to the facility. Civil penalty of $200 will be assessed today.


See LIC809D for citations issued:

Appeal Rights (1/16) were discussed and provided. Signature at the bottom of this report confirms receipt. Notice of Site Visit was posted during this visit and will remain posted for 30 days.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2019
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: ST. COLUMBA PRESCHOOL
FACILITY NUMBER: 372005946
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/16/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/17/2019
Section Cited

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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: Request a transfer of a criminal record clearance as specified in Section 101170(f)
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This requirement was not met as evidenced by: Teachers Holy Margaret Nguyen and substitute teacher Miriam Andrade fingerprint clearances are not associated to the facility. This poses a potential health and safety risk to clients in care.
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form is file out completely and will submit the form to Licensing prior to the individual start working at the facility.

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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: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:
DATE: 12/16/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/16/2019
LIC809 (FAS) - (06/04)
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