376600468-9-13-2022-20-CC-MMAE-CJ8R23-20220913123739

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376600468
Report Date: 09/13/2022
Date Signed: 09/13/2022 12:37:46 PM

Document Has Been Signed on 09/13/2022 12:37 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:	HARBORSIDE STATE PRESCHOOL		FACILITY NUMBER:	376600468
ADMINISTRATOR:	LISA FOREHAND		FACILITY TYPE:	850
ADDRESS:	681 NAPLES STREET		TELEPHONE:	(619) 425-2362
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91911
CAPACITY:	24	CENSUS: 15	DATE:	09/13/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:02 AM
MET WITH:	Janice Galarza		TIME COMPLETED:	01:00 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 9/13/22 at 9:45am, Licensing Program Analyst (LPA), Martha Malane conducted an unannounced annual inspection and met with Lead Teacher, Janice Galarza. LPA disclosed the purpose of the inspection and was led on a tour of the facility. This is an AM and PM program which operates on a year-round schedule. Days and hours of operation are Monday – Friday 7:45am – 10:45am and 11:45am – 2:45pm. There were 15 children and three (3) staff members present. Furniture and equipment are in good condition. Playground equipment is in safe condition. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. Areas around high climbing equipment and slide have rubber matting for cushioning to absorb falls. Toilet and hand-washing equipment are in safe and sanitary operating condition. Floors in the facility are clean and safe. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors. Facility does not have a functioning carbon monoxide detector, see LIC809D for deficiency cited. The last fire/disaster drill was conducted and documented 8/30/22. Lead teacher stated there are no bodies of water on the premises and LPA did not observe any bodies of water. Lead teacher stated there are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. No poisons were observed. Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions through the Chula Vista Elementary School District (CVESD). Capacity and limitations as specified on the license are being maintained. At least one person trained in CPR and Pediatric First Aid is present when children are at the facility. The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. Children are under supervision, including visual supervision, of a teacher at all times. Facility maintains a ratio of one teacher supervising no more than 12 children in care. See LIC809C continuation...

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha Malane	TELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022

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: HARBORSIDE STATE PRESCHOOL	FACILITY NUMBER: 376600468
	VISIT DATE: 09/13/2022

NARRATIVE

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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. Staff health screening, immunization records for influenza, pertussis and measles through CVESD. Staff did not have current documentation of completed AB1207 mandated reporter training on file, see LIC809D for deficiency cited.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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 lead teacher discussed the Community Care Licensing website www.ccld.ca.gov which will provide access California Megan’s Law (www.meganslaw.ca.gov), Lead Poisoning Facts and PIN 21-21-CCP: Lead Testing of Water in Licensed Child Care Centers Per AB 2370, Forms and Regulations.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations deficiencies were cited. LIC9213 Notice of Site Visit is provided and required to be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted with Lead Teacher, Janice Galarza

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.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha Malane	TELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/13/2022 12:37 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: HARBORSIDE STATE PRESCHOOL	FACILITY NUMBER: 376600468
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/13/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1503.2

Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections. 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 in the facility did not have an operational carbon monoxide detector which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/30/2022
	Plan of Correction
1 2 3 4	Facility staff stated they will send proof of an operational carbon monoxide detector to CCL by 9/30/22.

Type B

Section Cited

HSC

1596.8662(b)(1)

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview, and record review, the licensee did not comply with the section cited above as three (3) out of three (3) staff did not have current AB1207 Mandated Reporter Training certification on file which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/30/2022
	Plan of Correction
1 2 3 4	Facility staff stated they will submit proof of current AB1207 Mandated Reporter Training certification for all staff to CCL by 9/30/22 see mandatedreporterca.com.

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: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha Malane	TELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022

LIC809 (FAS) - (06/04)

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