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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600687
Report Date: 03/16/2023
Date Signed: 03/16/2023 11:03:37 AM


Document Has Been Signed on 03/16/2023 11:03 AM - 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:CAJON VALLEY STATE PRESCHOOL - NARANCA ELEMENTARYFACILITY NUMBER:
376600687
ADMINISTRATOR:MIKE SERBANFACILITY TYPE:
850
ADDRESS:1030 NARANCA AVENUETELEPHONE:
(619) 588-3087
CITY:EL CAJONSTATE: CAZIP CODE:
92021
CAPACITY:23CENSUS: 21DATE:
03/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:PM Lead Teacher Antonia ArellanoTIME COMPLETED:
11:10 AM
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On 3/16/2023 at 9:15 a.m., Licensing Program Analyst (LPA), Joelle Redding, met with PM Lead Teacher Antonia Arellano, for the purpose of an unannounced annual inspection. There were 21 children present with two lead teachers and two aides in Room 43. Facility is within ratio and capacity.

LPA toured the facility. The room was clean, orderly and a comfortable temperature during this visit. Adequate ventilation and heating are available. The furniture, books, games and toys are safe, age-appropriate and in good repair. There are a variety of activities available throughout the day. All required forms were posted. All storage containers and trashes containing solid waste have tight fitting lids and are in good repair. Snack food meets the nutritional requirements per regulation and is of good quality and proper quantity. The snack menu is posted, changes are recorded, and menus are stored for 30 days. Food has been stored separately from any chemicals or cleaning products. Drinking water is readily available. Hand washing and toileting areas are in a safe, sanitary and operating condition. Any waste water used to clean is being discarded after use. Medications are kept both here and in the school office, inaccessible to children. Poisons, disinfectants, cleaning solutions and other items that are dangerous to children have been made inaccessible. There is no evidence of rodent or insect activity.

Outdoor play area is fully fenced with sufficient cushioning and adequate shade. A new play structure was installed on the shared playground space that is labeled for 5-12 years. Children under 5 have been using the entire structure. LPA instructed the facility that only the lower portions of the structure can be used and only with direct supervision. Outdoor surfaces are in a safe condition with any equipment securely bolted to the ground. Portable water is used outdoors. There are no bodies of water, firearms or ammunition on the property. The carbon monoxide detector is operational. The facility has a written disaster plan in place that meets regulatory requirement and has been conducting and documenting evacuation drills every six months. Last drill was 2/28/23. The facility does not transport children.

SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/16/2023
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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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: CAJON VALLEY STATE PRESCHOOL - NARANCA ELEMENTARY
FACILITY NUMBER: 376600687
VISIT DATE: 03/16/2023
NARRATIVE
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 LPA reviewed sign in/out sheets (electronic via Learning Genie), a sample of personnel records and a sample of children's records. There is at least one staff present with current CPR and First Aid certification. Mandated Reporter training is current.

Children are evaluated upon entry and monitored throughout the day for signs of illness. The isolation area for ill children awaiting pick up a quiet area of the classroom or the nurse's office, depending on the severity of the illness. Reporting requirements for positive Covid-19 results in children or staff were discussed to include contact with County Department of Public Health for guidance (619-692-8499) and Licensing (619-767-2248) to report the unusual incident for three or more cases.

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 . Services are in place today.



Staff was 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.

Licensee is signed up for Quarterly Updates and Provider Information Notices (PINs) for one or more programs on our website: www.ccld.ca.gov.



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, visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process
SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: CAJON VALLEY STATE PRESCHOOL - NARANCA ELEMENTARY
FACILITY NUMBER: 376600687
VISIT DATE: 03/16/2023
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LPA conducted child care quality management interview with PM Lead Teacher Antonia Arellano. Exit interview conducted and report was reviewed with Ms. Arellano..

See LIC 809D for Type B deficiency.

NOTICE OF SITE VISIT WAS GIVEN AND WILL REMAIN POSTED FOR 30 DAYS.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 03/16/2023 11:03 AM - 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: CAJON VALLEY STATE PRESCHOOL - NARANCA ELEMENTARY
FACILITY NUMBER: 376600687

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101239(m)
Fixtures, Furniture, Equipment and Supplies. All play equipment and materials used by children shall be age-appropriate.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, preschool children under the age of 5 years were using a play structured labeled for children 5-12 years. This is a potential hazard to the health and safety of children in care.
POC Due Date: 03/31/2023
Plan of Correction
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Ms. Arellano will provide a copy of the Licensing report to Kathleen Cordero in the District office for correction by the plan of correction date of 3/31/23 and in the meantime, both morning and afternoon teachers will not allow any children on the structure as they want to be fair to all the children 3 to 5 years.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 03/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/16/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4