376600808-1-26-2023-20-CC-JARL-CNFRCG-20230126115416

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376600808
Report Date: 01/26/2023
Date Signed: 01/26/2023 11:54:35 AM

Document Has Been Signed on 01/26/2023 11:54 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:	CENTRAL ELEMENTARY STATE PRESCHOOL		FACILITY NUMBER:	376600808
ADMINISTRATOR:	ANGELICA HUESO-GARCIA		FACILITY TYPE:	850
ADDRESS:	4063 POLK AVENUE		TELEPHONE:	(619) 344-6100
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92105
CAPACITY: 48	TOTAL ENROLLED CHILDREN: 48	CENSUS: 36	DATE:	01/26/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Linda Thomas		TIME COMPLETED:	10:30 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 January 25^TH, 2023 at 8:20 AM, Licensing Program Analyst (LPA) Jo Ann Legaspi, conducted an unannounced Annual Inspection and met with Lead Teacher Linda Thomas. LPA disclosed the purpose of the inspection and toured the facility indoors and outdoors. This is a full day program. There are currently two classrooms in operation. The following ratios were observed: Classroom # 15 (serves children ages 3 years through 5 years): There were seventeen (17) children present with three (3) staff members. Classroom # 17 (serves children ages 3 years through 5 years): There were nineteen (19) children present with three (3) staff members. There is no swimming pool or other bodies of water on the premises. 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 during the inspection. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. Playground equipment is in safe condition, free of sharp, loose, or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All toilets and handwashing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe. All kitchen, food preparation and storage areas are clean, free of litter/rubbish and free of rodents/vermin. Food is protected against contamination and any contaminated food is discarded immediately. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors. Areas around high climbing equipment, swings and slides have cushioning material to absorb falls. The facility is free of flies, insects, and rodents. Facility has one or more functioning carbon monoxide detectors that meet

Tulam Vu
JoAnn R Legaspi
	DATE: 01/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023

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: CENTRAL ELEMENTARY STATE PRESCHOOL	FACILITY NUMBER: 376600808
	VISIT DATE: 01/26/2023

NARRATIVE

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statutory requirements.

Staff 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

Capacity and limitations as specified on the license are being maintained. The name of the childcare center director or fully-qualified teacher designated to act in the director’s absence has been reported to the Department. The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. All 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. 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. Menus are posted at least one week in advance where an authorized representative can view them.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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

Lead Teacher Thomas was reminded that the failure of a licensee to pay all applicable and accrued fees and civil penalties shall constitute grounds for forfeiture of a license.

LPA and Lead Teacher Linda Thomas discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, CCL Child Care Advocate Program, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, California Megan’s Law (www.meganslaw.ca.gov), Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, no deficiencies are cited.

SUPERVISOR'S NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023

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: CENTRAL ELEMENTARY STATE PRESCHOOL	FACILITY NUMBER: 376600808
	VISIT DATE: 01/26/2023

NARRATIVE

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A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Lead Teacher Thomas.

An exit interview was conducted with Lead Teacher Thomas, who was provided a copy of their appeal rights (LIC 9058).

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
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023

LIC809 (FAS) - (06/04)

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