376105070-10-14-2021-51-CC-SSIO-C7SRVK-20211014132141

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376105070
Report Date: 10/14/2021
Date Signed: 10/14/2021 01:21:51 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:	CAJON VALLEY MADISON ELEMENTARY STATE PRESCHOOL		FACILITY NUMBER:	376105070
ADMINISTRATOR:	STEPHANIE DODDS		FACILITY TYPE:	850
ADDRESS:	1615 EAST MADISON AVENUE		TELEPHONE:	(619) 588-3077
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92019
CAPACITY:	48	CENSUS: 0	DATE:	10/14/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Ginny Pinkerton/Director of Early Childhood Programs		TIME COMPLETED:	01:35 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 10/14/2021 at 11:00am, Licensing Program Analyst, Selina Siao, conducted an announced change of location Pre-Licensing inspection. LPA met with Ginny Pinkerton, Director of Early Childhood Programs. The Preschool Program will operate in classroom 104 serving children ages 3-5 year old. The children will be in care Monday through Friday from 8am to 2:45pm. Facility recently submitted an updated application to indicate that the correct capacity for the program should be 24 children instead of 48. LPA Siao submitted an updated fire clearance today. Medications will be stored in the Health Services Office or the classroom depending the type of medication. All indoor and outdoor activity space utilized for the children was inspected and measured today: Indoor: · Room 104 measures 927.09 square feet, which will accommodate a total of 26 children. Outdoor: · The preschool outdoor enclosed playground area that is located directly outside the classroom measures 6540.16 square feet, which will accommodate no more than 87 children at one time. Facility will be using the playground with the Special Education preschool children but they are supervised by the special education staff as part of the inclusion program. The room is complete with age-appropriate furniture and equipment, including tables, chairs, cubbies, bookshelves, and other activity supplies for the children. There are 2 toilets and 2 sinks inside the preschool classroom which is sufficient for 30 children. Children are to be supervised by staff when children are inside the restroom. There is a separate

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina Siao	TELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021

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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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: CAJON VALLEY MADISON ELEMENTARY STATE PRESCHOOL	FACILITY NUMBER: 376105070
	VISIT DATE: 10/14/2021

NARRATIVE

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bathroom and isolation room for children who are ill located at the Elementary campus health office. There is a carbon monoxide detector located on the wall near the classroom supply room. District menu is posted, as well as all other required documents for the parents and employees. Facility will continue to have a drive up drop off and pick up system by using a digital sign-in and out system with a QR code where parents signed in on their own phone.

The outdoor play area was inspected. Area is completely fenced, have storage and a small tree for shade, age appropriate play equipment, and the wood chips needs to be move to be under the high climbing structure, slides and swings areas to ensure sufficient cushioning to ensure children's safety. Drinking water is readily accessible via portable jug when children are inside and outside.

This facility plans to provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A 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. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

Staff members have the required background clearances through the school district. Child Care Providers can now sign up for Quarterly Updates through the DSS website https://cdss.ca.gov/inforesources/community-care-licensing/subscribewww.ccld.ca.gov .

Prior to licensure, the following is needed:
- Fire Marshall clearance

Exit interview was conducted. Once the above are corrected and a final file review is conducted, a license for 24 children will be granted. The licensee representative was provided a copy of their appeal rights (LIC 9058 12/15).

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina Siao	TELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021

LIC809 (FAS) - (06/04)

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