376600639-2-10-2023-20-CC-RGOU-CNWQWC-20230210113143

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376600639
Report Date: 02/10/2023
Date Signed: 02/10/2023 01:09:01 PM

Document Has Been Signed on 02/10/2023 01:09 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:	KIMBROUGH STATE PRESCHOOL		FACILITY NUMBER:	376600639
ADMINISTRATOR:	HERNAN BAEZA		FACILITY TYPE:	850
ADDRESS:	321 HOITT STREET		TELEPHONE:	(619) 362-4400
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92102
CAPACITY:	24	CENSUS: 12	DATE:	02/10/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Hernan Baeza		TIME COMPLETED:	11:45 AM

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 02/10/23, at 8:40 a.m., Licensing Program Analyst (LPA), Rajani Goudreau conducted an unannounced Annual Inspection and met with Director, Hernan Baeza. LPA disclosed the purpose of the inspection and toured the facility indoors and outdoors. This is an AM/PM half day program which operates on a traditional school year schedule following the San Diego Unified School District. The preschool operates at Kimbrough Elementary School. The preschool program operates Monday through Friday from 7:40 a.m. to 10:40 a.m. and 11:15 a.m. to 2:15 p.m. There is one classroom in operation: K2. The following ratios were observed:12 children with four staff members. There is no swimming pool or other bodies of water on the premises, per observation. There are no firearms or ammunition on the premises, per director. 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 were observed to be in good condition, free of sharp, loose or pointed parts. The playground equipment and play materials were observed to be in safe condition, free of sharp, loose or pointed parts. The play structure and swings are suitable for ages 2 through 5 years old, per observation. The surface of the outdoor activity space was observed to be maintained in a safe condition and is free of hazards. There is sufficient rubber matting material to absorb falls under and around the play structure and swings. In addition, there is shade during outdoor play by the use of a large roof shade. The children utilize a girls and boys restrooms located between classrooms K4 and K3 each containing one toilet and one sink. Also, the children utilize a boys and girls restrooms in classroom K2 each containing one toilet and one sink. All toilets and hand washing facilities were observed to be in safe and sanitary operating condition. The floors in the facility were observed to clean and safe Drinking water is available both indoors and outdoors by the use of water fountains and disposable cups provided by the facility or brought from home. Breakfast, Lunch and snack is provided by the facility. Based on observation, the facility has one functioning carbon monoxide detector and a first aid kit that meets requirements.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

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 02/10/2023 01:09 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: KIMBROUGH STATE PRESCHOOL	FACILITY NUMBER: 376600639
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/10/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(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 file review, the licensee did not comply with the section cited above as three staff did not complete the AB1207 - Mandated Reporter Training, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/10/2023
	Plan of Correction
1 2 3 4	LPA discussed the mandated reporter training requirements. Director indicated the preschool staff will complete the mandated reporter training and once complete will provide the certificates to the Department. LPA provided the director with the following website in order to complete the training: https://mandatedreporterca.com. Plan of correction shall be submitted to the Department by March 10, 2023.

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: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

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: KIMBROUGH STATE PRESCHOOL	FACILITY NUMBER: 376600639
	VISIT DATE: 02/10/2023

NARRATIVE

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Capacity and limitations as specified on the license are being maintained, per observation. At least one person trained in CPR and Pediatric First Aid is present when children are at the facility, based on file review. The name of the childcare center director or fully qualified teacher(s) designated to act in the director’s absence has been reported to the Department, per file review. Sign in/out sheets reviewed and observed to have the parent’s/authorized representative’s full legal signatures and record the time of day. Children were observed to be under supervision, including visual supervision. Based on observation, the facility maintains a ratio of one teacher supervising no more than eight children in care. 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. However, five out of the six files reviewed were missing the medical assessment (LIC701) form. LPA reviewed a sample of staff files and observed files were complete with health screening, immunization records for influenza, pertussis and measles. However, three staff files were missing documentation of the completed mandated reporter training. Required documents were observed to be posted in the classroom. The preschool classroom, K2 shares the restrooms and outdoor space with the elementary students. Shared outdoor space waiver in place. However, there is no restroom waiver for the shared restroom usage with the elementary students.

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.

This facility does not provide Incidental Medical Services (IMS). Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Section 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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. Services are in place.

The following is pending with a due date of March 10, 2023:

Transfer fingerprint clearance for licensee designee to current facility.
Provide a statement signed and dated by licensee designee reflecting classroom designation for the preschool license.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

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: KIMBROUGH STATE PRESCHOOL	FACILITY NUMBER: 376600639
	VISIT DATE: 02/10/2023

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 26 27 28 29 30 31 32	Shared restroom waiver request. Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiency is being cited on the attached LIC809 D page. An exit interview was conducted with Director, Hernan Baeza. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

LIC809 (FAS) - (06/04)

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