372005988-5-12-2023-51-CC-NDIZ-CRRTNX-20230512145327

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 372005988
Report Date: 05/12/2023
Date Signed: 05/12/2023 02:53:39 PM

Document Has Been Signed on 05/12/2023 02:53 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:	ST. THERESE ACADEMY PRE-K		FACILITY NUMBER:	372005988
ADMINISTRATOR:	MELBA JIMENEZ		FACILITY TYPE:	850
ADDRESS:	6440 SAINT THERESE WAY		TELEPHONE:	(619) 583-1493
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92120
CAPACITY:	60	CENSUS:	DATE:	05/12/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:			TIME 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	On 5/12/23 @ 1:20pm, LPA Nancy Diaz conducted an unannounced inspection. LPA disclosed the purpose of the inspection and was granted facility entry by Rachel Verdugo. LPA toured the facility with Ms. Verdugo. Observed present today were 40 napping children in the following rooms: Pre-K 1 with 17 napping children and staff Susan Conley, Erika Limon & Maria Martinez. Pre-K 2 with 23 napping children and staff Alicia Alonzo, Nancy Chamberlain and Christine Russell. There are 2 classrooms designated for children's use. Program operates Monday-Friday; 7:30am to 5:30pm. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. The licensee has not exceeded the conditions, limitations and capacity specified on the license. The ass't director and all the staff are trained in CPR and Pediatric First aid. Certificates were observed on file. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are inaccessible. Medications are kept in a safe place, inaccessible to children. Furniture and equipment are in good condition, free of sharp, loose or pointed parts. All toilets, handwashing facilities are in safe and sanitary operating condition. All floors are clean and safe. The child care center was observed to be clean, safe, sanitary and in good repair to ensure the safety and well-being of children, employees and visitors. Facility maintains a carbon monoxide detector that meet the standards established in Chapter 8 of Part 2 of Division 12. Playground equipment was observed to be in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space are maintained in safe condition and free of hazards. The areas around or under high climbing equipment, swings, slides, and similar equipment was cushioned with material that absorbs a fall.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy Diaz	TELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023

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

Document Has Been Signed on 05/12/2023 02:53 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: ST. THERESE ACADEMY PRE-K	FACILITY NUMBER: 372005988
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101226(e)(2)

Health-Related Services

(2) All prescription and nonprescription medications shall be maintained with the child's name and shall be dated. 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. LPA observed one child's Epi-pen not labeled with child's name or prescription. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/19/2023
	Plan of Correction
1 2 3 4	Ms. Verdugo stated that she will speak with the parent today and notify her that the child's Epi-pen need to be in its original container with the child's name and prescription. Ms. Verdugo shall submit a photo of the child's Epi-pen to the department no later than 5/19/23. Send via email to - nancy.diaz@dss.ca.gov

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: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy Diaz	TELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023

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: ST. THERESE ACADEMY PRE-K	FACILITY NUMBER: 372005988
	VISIT DATE: 05/12/2023

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
26
27
28
29
30
31
32

Children were observed to be under the supervision of qualified staff. Facility was observed to be within ratio. An isolation area has been designated for children who becomes ill during the day.

Children’s records were reviewed today. All required forms were on file. Menus are posted in a place visible by the child’s authorized representative. All children are signed in/out by a representative who uses a full legal signature and has recorded the time of day. Child’s record also contain a medical assessment.

Staff records reviewed today contain a health screening as required by the regulation. Staff have completed the mandated reporter training (effective 3/2018). This training shall be renewed every two years. All staff have immunization record indicating that they have been immunized against influenza, pertussis and measles.

Incidental Medical Services (IMS) policy was discussed. Facility maintains Epi-pens and nebulizers for children. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Ms. Verdugo was reminded that all adults 18 and over, 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.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy Diaz	TELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023

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: ST. THERESE ACADEMY PRE-K	FACILITY NUMBER: 372005988
	VISIT DATE: 05/12/2023

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
26
27
28
29
30
31
32

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/process.

TYPE B DEFICIENCY WAS CITED TODAY.

Exit interview conducted and report was reviewed with facility representative, Rachel Verdugo. A copy of this report, along with Appeal Rights (LIC9058), were provided. A notice of site visit was given and must remain posted for 30 days. LPA observed that the notice of site visit was posted during the inspection. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy Diaz	TELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023

LIC809 (FAS) - (06/04)

Page: 4 of 4