376600493-5-2-2022-51-CC-KLAE-CE2SA8-20220502134154

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376600493
Report Date: 05/02/2022
Date Signed: 05/02/2022 01:42:10 PM

Document Has Been Signed on 05/02/2022 01:42 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:	NORTH CITY PRESCHOOL		FACILITY NUMBER:	376600493
ADMINISTRATOR:	KAREN KNUDSEN		FACILITY TYPE:	850
ADDRESS:	11717 POWAY ROAD		TELEPHONE:	(858) 748-4678
CITY:	POWAY	STATE: CA	ZIP CODE:	92064
CAPACITY:	77	CENSUS: 53	DATE:	05/02/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Karen Knudsen		TIME COMPLETED:	02:00 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 5/2/22 at 9:30 AM, Licensing Program Analyst (LPA) Keturah Lane visited the facility to conduct an annual inspection. Upon arrival LPA met with Director Karen Knudsen and proceeded to tour the facility. During today's inspection, there were 53 children with 10 staff in 6 classrooms. Appropriate ratios and capacity were observed. Appropriate care & visual supervision were also observed during the inspection. LPA observed some of the children playing on the playground, some children eating snack in classroom and others involved in activities inside and outside of the classrooms. Furniture and age appropriate equipment is in good condition. Rooms have adequate heating, lighting, ventilation. Floors appear to be clean and safe. Drinking water is readily accessible. Bathrooms are maintained with operational toilets and faucets with appropriate temperature. Paper towels and toilet paper are available. Bathroom is lighted and has ventilation. Food service area consists of a kitchen which is clean and free of hazards. Menu is posted. Adequate food is available for snacks/meals for extended care. Children bring morning snack and lunch from home. Cleaning supplies are kept separate from food and are inaccessible to children. Storage containers for solid waste have tight-fitting covers and are kept in good repair. Storage areas for poisons are locked. Director stated there are no firearms or other weapons on the premises. All foods/beverages capable of rapid spoiling are stored in covered containers at 45 F or less. The facility appears to be free of insects and rodents. There is an operational carbon monoxide detector at the facility. Last fire drill was conducted on 4/27/22. (continued on LIC809-C...)

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Keturah Lane	TELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2022

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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Document Has Been Signed on 05/02/2022 01:42 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: NORTH CITY PRESCHOOL	FACILITY NUMBER: 376600493
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/02/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101170(e)(2)

Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 101170(f) or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in one out of twelve persons which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/09/2022
	Plan of Correction
1 2 3 4	Director will submit transfer of clearance paperwork to Licensing office by 5/9/22 for staff member #1 and ensure she has been associated to the facility. Director will submit proof of association to LPA Lane via e-mail.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Keturah Lane	TELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2022

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: NORTH CITY PRESCHOOL	FACILITY NUMBER: 376600493
	VISIT DATE: 05/02/2022

NARRATIVE

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Outdoor play area is a fenced playground with sufficient material for cushioning. There are no bodies of water or weapons at this facility. Climbing structures, swings and slides are securely fixed to the ground. Area has ample trees used for shade. Equipment is age appropriate. Area has drinking water readily accessible and grounds are free of debris or potential hazards.

LPA reviewed medication storage. Personnel records contain health screening documentation and at least one staff member has current CPR and First Aid certifications. All staff have completed mandated reporter training and required immunizations. Each personnel record contains documentation of educational background and training. Sign ins were reviewed. Children’s records contain admission agreements and medical assessment. A review of staff records on this date indicates that staff member #1 had a background clearance but was not associated to the facility. All other facility staff were cleared and associated to the facility. Facility representative 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.

LPA obtained updated documents from Director: LIC610 Emergency Disaster Plan, LIC308 Designation of Responsibility and the Incidental Medical Services plan to update the facility file.

Pursuant to Title 22 of the CA Code of Regulations, the following Type B deficiency was cited (refer to LIC 809-D). Civil penalties were assessed in the amount of $100. Facility representative was provided a copy of Civil Penalties Assessment LIC421BG.
(continued on LIC809-C...)

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Keturah Lane	TELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2022

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: NORTH CITY PRESCHOOL	FACILITY NUMBER: 376600493
	VISIT DATE: 05/02/2022

NARRATIVE

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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

Exit interview conducted and report was reviewed with the facility representative, Director Karen Knudsen. Notice of site visit was given and must remain posted for 30 days.

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.

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Keturah Lane	TELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2022

LIC809 (FAS) - (06/04)

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