<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372005946
Report Date: 01/16/2020
Date Signed: 01/16/2020 02:57:50 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: 47DATE:
01/16/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:01 PM
MET WITH:Lori JiannuzziTIME COMPLETED:
03:15 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
Licensing Program Analyst (LPA) Samantha Salunga completed an unannounced case management inspection to issue a deficiency regarding an unusual incident that was reported to the department on 11/15/2019, however was not followed up with a completed Unusual Incident/Injury Report (LIC624). Upon arrival, LPA met with Center Director, Lori Jiannuzzi, and conducted a tour of the facility. LPA counted a total of 47 children in care. Appropriate teacher and child ratio were observed during today's inspection.

Child Care Licensing (CCL) received information from the facility stating they had made a Child Protective Services report on 11/15/2019 regarding a child who arrived at the facility with red marks on the wrists. Facility was notified that LIC624 was to be submitted within seven days. Facility failed to submit a LIC624 to CCL.

See LIC809D for cited deficiency. Director was provided a copy of appeal rights (LIC 9058 01/16) and her signature on this form acknowledges receipt of these rights. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA observed Director post notice of site visit.

Access our updated Regulation & Forms by using our WEBSITE: http://ccld.ca.gov
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha SalungaTELEPHONE: (619) 767-2209
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2020
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 2
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: 01/16/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/31/2020
Section Cited

1
2
3
4
5
6
7
Reporting Requirements...a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurence of such event. Facility failed to submit LIC624 following up on their
8
9
10
11
12
13
14
 initial notification to CCL of an incident where facility staff made a report to Child Protective Services regarding a child who had red marks on the wrists. This poses a Potential Health and Safety risk to the clients in care.
8
9
10
11
12
13
14
is submitted within seven days.

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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: Samantha SalungaTELEPHONE: (619) 767-2209
LICENSING EVALUATOR SIGNATURE:
DATE: 01/16/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/16/2020
LIC809 (FAS) - (06/04)
Page: 2 of 2