376600164-3-22-2021-51-CC-GCUS-BZCREP-20210322125751

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376600164
Report Date: 03/22/2021
Date Signed: 03/22/2021 12:59:01 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 PRESCHOOL - INFANT		FACILITY NUMBER:	376600164
ADMINISTRATOR:	ANGELA SIROTA		FACILITY TYPE:	830
ADDRESS:	4750 MISSION GORGE PLACE		TELEPHONE:	(619) 287-4900
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92120
CAPACITY:	36	CENSUS: 20	DATE:	03/22/2021
TYPE OF VISIT:	Case Management - Deficiencies	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Evelyn Kensel		TIME COMPLETED:	12:30 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	Covid-19 State of Emergency On 3/22/21 at 11:30 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 20 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. On 2/8/21, Community Care Licensing received a phone call to report a concern that the parent of a day care child tested positive for COVID-19 and it was not handled appropriately as it was not reported to Licensing or the Department Public Health. The Department was not aware of the Covid-19 exposure until LPA Curtis contacted the facility on 2/17/21. LPA was advised that a family member (relation unknown) of a daycare child (C1) began showing Covid-19 symptoms on 2/6/21 and tested positive for Covid-19 on 2/7/21. The facility was notified of the positive result on 2/8/21. The child (C1) was last in the facility on 2/5/21. The director states that the Department of Public Health was contacted on 2/8/21 and that C1 would need to quarantine. They were advised that no further action was needed as the positive person was not on site for longer than 15 minutes. The director states that the effected classroom was deep cleaned the morning of 2/8/21 before the children arrived. C1` was tested for Covid-19 and the results were negative. The Unusual Incident /Injury Report, LIC624 was received by the Department via email and fax on 2/19/21. The report confirmed that it was the father of C1 who tested positive for Covid-19 and that he dropped the child off the morning of 2/5/21. The director did notify the Department of the Covid-19 exposure by the next business day nor was the written report received within seven days of the incident. Please see LIC809D for cited deficiency.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace Curtis	TELEPHONE: (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)

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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: MISSION NAZARENE PRESCHOOL - INFANT	FACILITY NUMBER: 376600164
	VISIT DATE: 03/22/2021

NARRATIVE

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LPA emailed Covid-19 resources to the Director including links to the California Department of Public Health (CDPH), Local County Public Health Department, Center for Disease Control (CDC) and the California Department of Social Services (CDSS) webpage where Provider Information Notices (PIN’s) can be found.

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 Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace Curtis	TELEPHONE: (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)

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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: MISSION NAZARENE PRESCHOOL - INFANT	FACILITY NUMBER: 376600164
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/22/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/02/2021 Section Cited	1 2 3 4 5 6 7	101212 Reporting Requirements: (d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. (1) Events reported shall include the following: (B) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child. This requirement was not met as evidenced by:
	8 9 10 11 12 13 14	Based on LPA's record review & interview with the director the Dept was not verbally notified of the 2/7/21 Covid-19 exposure until 2/17/21. Written notification was not received until 2/19/21. This poses a potential health & safety risk to children in care.	8 9 10 11 12 13 14
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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 Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace Curtis	TELEPHONE: (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)

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