376600133-5-25-2022-20-CC-RGOU-CERSJM-20220525135521

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376600133
Report Date: 05/25/2022
Date Signed: 05/25/2022 01:56:29 PM

Document Has Been Signed on 05/25/2022 01:56 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:	AKA HEAD START - SAN MIGUEL		FACILITY NUMBER:	376600133
ADMINISTRATOR:	DANIELLE ANGELETTE		FACILITY TYPE:	850
ADDRESS:	7059 SAN MIGUEL AVENUE		TELEPHONE:	(619) 460-6611
CITY:	LEMON GROVE	STATE: CA	ZIP CODE:	91945
CAPACITY:	86	CENSUS: 39	DATE:	05/25/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:34 AM
MET WITH:	Faviola Mojica		TIME COMPLETED:	02:15 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 05/25/22 at 10:34 a.m., Licensing Program Analyst (LPA), Rajani Goudreau conducted an unannounced Annual Inspection and met with Assistant Director, Faviola Mojica. LPA disclosed the purpose of the inspection and toured the facility indoors and outdoors. This is a full day program/AM half day program which operates with the traditional school year schedule with Lemon Grove School District. Days and hours of operation are Monday through Friday, full day program operates 8:00 a.m. through 4:00 p.m. and AM program operates 8:00 a.m. through 11:30 a.m. There are currently four classrooms in operation.The following ratios were observed: Classroom #1: 1 staff member/7 children, Classroom #2: 2 staff members/15 children, Classroom #3: 2 staff members/6 children, Classroom #4: 3 staff members/11 children. There were 39 children present with eight staff members. There is no swimming pool or other bodies of water on the premises, per observation. There are no firearms or ammunition on the premises, per Assistant Director. Disinfectants, cleaning solutions, medication and other hazardous items were made inaccessible, per observation. No poisons were observed during the inspection. Furniture and equipment in the classrooms were observed to be in good condition, free of sharp, loose or pointed parts. The playground equipment and play materials were observed to be in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space was observed to be maintained in a safe condition and is free of hazards. All toilets and hand washing facilities were observed to be in safe and sanitary operating condition. The floors in the facility were observed to clean and safe. The kitchen, food preparation and storage areas were observed to be clean. Solid waste storage containers were observed to have tight-fitting covers and in good repair. Drinking water is available both indoors and outdoors by the use of refillable water containers and disposable cups provided by the facility. Areas around high climbing equipment were observed to have sufficient rubber cushioning to absorb falls. Shade was observed in the outdoor activity space by the use of canopies. Based on observation, the facility has one or more functioning carbon monoxide detector that meet statutory requirements. See LIC809-C continuation page...

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2022

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: AKA HEAD START - SAN MIGUEL	FACILITY NUMBER: 376600133
	VISIT DATE: 05/25/2022

NARRATIVE

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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. Upon notification from the Department, the licensee will comply and act immediately to terminate the employment of, remove from the facility or bar from entering the facility for any person it is deemed necessary while the Department considers granting or denying an exemption. Capacity and limitations as specified on the license are being maintained, per observation. At least one person trained in CPR and Pediatric First Aid is present when children are at the facility, per file review. The name of the childcare center director or fully qualified teacher(s) designated to act in the director’s absence has been reported to the Department, per file review. Sign in/out sheets reviewed and observed to have the parent’s/authorized representative’s full legal signatures and record the time of day. Children were observed to be under supervision, including visual supervision. Based on observation, the facility maintains a ratio of one teacher supervising no more than 12 children in care. LPA reviewed a sample of children’s files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child and medical assessment. LPA reviewed a sample of staff files and observed files were complete with health screening, immunization records for influenza, pertussis and measles and current documentation of completed mandated reporter training. Menus are posted at least one week in advance where an authorized representative can view them.

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/inspection-process. See LIC809-C continuation page...

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2022

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: AKA HEAD START - SAN MIGUEL	FACILITY NUMBER: 376600133
	VISIT DATE: 05/25/2022

NARRATIVE

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Assistant Director 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.

This facility provides Incidental Medical Services (IMS). LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

No deficiencies issued during today's visit. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted with the Assistant Director, Faviola Mojica.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2022

LIC809 (FAS) - (06/04)

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