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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600162
Report Date: 03/22/2021
Date Signed: 03/22/2021 12:47:02 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:MISSION NAZARENE PRESCHOOLFACILITY NUMBER:
376600162
ADMINISTRATOR:ANGELA SIROTAFACILITY TYPE:
850
ADDRESS:4750 MISSION GORGE PLACETELEPHONE:
(619) 287-4900
CITY:SAN DIEGOSTATE: CAZIP CODE:
92120
CAPACITY:114CENSUS: 43DATE:
03/22/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Evelyn KenselTIME COMPLETED:
11:44 AM
NARRATIVE
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Covid-19 State of Emergency
On 3/22/21 at 11:00 a.m. Licensing Program Analyst (LPA) Leilani Curtis conducted an unannounced case management inspection via Zoom. Upon arrival LPA met with Director Evelyn Kensel and proceeded to tour the facility. Also present were 43 children with 8 staff members. Appropriate teacher and child ratios were observed. Staff members have the required background clearances and are associated to the facility.

Effective 2/08/21, Evelyn Kensel became the director of Mission Nazarene Preschool. An email announcing her position was sent by the Mission Nazarene Preschool Board to the preschool staff and parents on 2/8/21. The Licensee failed to submit Ms. Kensel’s “director’s packet”, including verification of course work and summary of work experience within 10 days of the facility director change. Ms. Kensel submitted the documents via email to LPA Curtis on 2/19/21 and original copies were received by the Community Care Licensing Regional Office on 2/22/21. The Licensee also failed to provide a written statement of the administrative responsibility and authority delegated to the child care center director, Evelyn Kensel.

Ms. Kensel understands that the Designation of Administrative Responsibility (LIC 308) signed by the Licensee/CEO and a New Personnel Summary (LIC500) to reflect staff changes will need to be submitted to LPA by 3/23/21. Ms. Kensel states that she has completed the Child Care Center Record Keeping Orientation. Ms. Kensel will also provide LPA with a copy of the completion certificate by 3/23/21.

See LIC809D for cited deficiency/cies.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2021
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 3
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: MISSION NAZARENE PRESCHOOL
FACILITY NUMBER: 376600162
VISIT DATE: 03/22/2021
NARRATIVE
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An exit interview was conducted with Director Kensel and Appeal Rights (LIC 9058 1/16) were discussed. A copy of this report as well as a copy of the Appeal Rights were emailed to the Director at the conclusion of the inspection. The Director will confirm receipt of this report via e-mail and the reply of confirmation will serve as the signature acknowledging these rights. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: MISSION NAZARENE PRESCHOOL
FACILITY NUMBER: 376600162
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/22/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/23/2021
Section Cited

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101212 Reporting Requirements:(b) The name of the child care center director... shall be reported to the Department within 10 days of a change of child care center director or designee(s). (1) Whenever a change in child care center director is reported, in addition to his/her name, the report shall include the following:(A) Verification of the completion of the course work required in Section 101215.1(h). A photocopy of a college transcript...This requirement was not met as evidenced by:
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Based on LPA's record review the Department received the required documents on 2/19/21. The director did not submit the documentation within 10 days of the director change. This poses a potential health and safety risk to children in care.
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Type B
03/23/2021
Section Cited

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101215.1 Child Care Center Directors Qualifications and Duties: (c) The child care center director shall be responsible for the operation of the center...(1)There shall be a clear written statement of the administrative responsibility and authority delegated to the child care center director.(A) A copy of this written statement shall be given to the child care center director and shall be made available to the Department upon request. This requirement was not met as evidenced by:
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Based on LPA's record review the director failed to submit a written statement of the administrative responsibility & authority given to her by the licensee (LIC308). This poses a potential health and safety risk to children in care.
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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: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3