376600515-11-16-2022-20-CC-RGOU-CL8UX9-20221116145759

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376600515
Report Date: 11/16/2022
Date Signed: 11/16/2022 02:58:21 PM

Document Has Been Signed on 11/16/2022 02:58 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:	LMSV-AVONDALE PRESCHOOL		FACILITY NUMBER:	376600515
ADMINISTRATOR:	JOHN ASHLEY		FACILITY TYPE:	850
ADDRESS:	8401 STANSBURY STREET #19		TELEPHONE:	(619) 668-5880
CITY:	SPRING VALLEY	STATE: CA	ZIP CODE:	91977
CAPACITY:	24	CENSUS: 0	DATE:	11/16/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Sofia Salazar		TIME COMPLETED:	03:10 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 11/16/2022, at 12:45 p.m., Licensing Program Analyst (LPA), Rajani Goudreau conducted an unannounced Annual Inspection and met with Lead Teacher, Sofia Salazar. LPA disclosed the purpose of the inspection and toured the facility indoors and outdoors. This is a part day program which operates under a traditional school year schedule following the La Mesa/Spring Valley School District (LMSV). The preschool is located at Avondale Elementary. The program is title 5. Days and hours of operation are Monday through Friday from 8:30 a.m. to 11:30 a.m. There is one classroom currently in operation; classroom #1 located in building #1. There were no children in care today due to parent conferences. There are no bodies of water on the premises of the property, per observation. Lead teacher confirmed there is no bodies of water on the premises of the property.There are no firearms or ammunition on the premises, per lead teacher. 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 classroom was observed to be in good condition, free of sharp, loose or pointed parts. The playground equipment were observed to be in safe condition, free of sharp, loose or pointed parts. There is a play structure in the outdoor area suitable for ages 2 through 5 years old. Also, there is sufficient cushioning under the play structure by the use of rubber matting. In addition, a climbing structure in the sand area with sufficient sand for cushioning. There is shade in the outdoor area by the use of shade canopies. The outdoor area is shared with the kindergarten children on a scheduled basis. Due to the shared outdoor space a waiver will need to be requested. The surface of the outdoor activity space was observed to be maintained in a safe condition and is free of hazards.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022

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: LMSV-AVONDALE PRESCHOOL	FACILITY NUMBER: 376600515
	VISIT DATE: 11/16/2022

NARRATIVE

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The program utilizes a shared restroom (girls) located at the end of building one containing four toilets and two sinks. The restroom is shared with the school age children. Due to the shared restroom usage a waiver will need to be requested. All toilets and hand washing areas were observed to be in safe and sanitary operating condition. The elementary school cafeteria provides breakfast and lunch to the children. Drinking water is available both indoors and outdoors by the use of refillable water containers and disposable cups provided by the facility. Based on observation, the facility has one functioning carbon monoxide detector and a first aid kit that meet requirements. Last disaster drills were conducted and documented on October 31, 2022.

A review of staff records on this date indicates that all facility staff or other individuals have received criminal record clearances. 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, per file review. 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. Menus are posted 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.

Lead teacher 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.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022

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: LMSV-AVONDALE PRESCHOOL	FACILITY NUMBER: 376600515
	VISIT DATE: 11/16/2022

NARRATIVE

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This facility provides Incidental Medical Services (IMS). There are no children in care receiving IMS services. IMS obtained at time of inspection. 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.

The following documents are pending with a due date of December 16, 2022:

LIC200A-Application reflecting total capacity of license. Signed by individual designated by the public agency.
LIC610 – Emergency Disaster Plan reflecting two relocation sites.
Updated LIC309 – Administrative organizations with second page under Public Agency filled out reflecting designated individual acting on behalf of the Public Agency under contact name.
Restroom waiver request due to shared restroom with the school age children.
Playground waiver request due to shared outdoor space with the school age children.
Licensee designee packet.
Director packet.

No deficiencies issued during today's inspection. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted with the Lead Teacher, Sofia Salazar.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022

LIC809 (FAS) - (06/04)

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