376600812-3-2-2022-20-CC-RGOU-CC5TSC-20220302135855

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376600812
Report Date: 03/02/2022
Date Signed: 03/02/2022 01:59:06 PM

Document Has Been Signed on 03/02/2022 01:59 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:	LEMON GROVE SCHOOL DISTRICT-MOUNT VERNON PRESCHOOL		FACILITY NUMBER:	376600812
ADMINISTRATOR:	VAZQUEZ, GUSTAVO		FACILITY TYPE:	850
ADDRESS:	8350 MOUNT VERNON STREET		TELEPHONE:	(619) 825-5600
CITY:	LEMON GROVE	STATE: CA	ZIP CODE:	91945
CAPACITY:	24	CENSUS: 10	DATE:	03/02/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:36 AM
MET WITH:	Melvetta Owens		TIME COMPLETED:	02:15 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 03/02/22, at 8:36 a.m., Licensing Program Analyst (LPA), Rajani Goudreau, conducted an unannounced Annual Inspection and met with Program Director, Melvetta Owens. 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. The morning program operates Monday through Friday (full day program) from 8:00 a.m. to 2:30 p.m. There is one classroom in operation; classroom R13. The following ratios were observed: two staff members and 10 children in care. 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. All poisons are kept in a locked storage area. 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 hand washing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe. 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 statutory requirements. Staff members are cleared through the Lemon Grove School District. At least one person trained in CPR and Pediatric First Aid is present when children are at the facility. The name of the childcare center director has not been reported to the Department. New principle/director, Dianne Teglia has been designated as the director of the preschool since September 2021. The change in director has not been reported to to the department, based on file review. LPA informed facility representative of the reporting requirements. 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. LPA reviewed a sample of children’s and staff members files. Required postings are posted in the classroom.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2022

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 03/02/2022 01:59 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: LEMON GROVE SCHOOL DISTRICT-MOUNT VERNON PRESCHOOL	FACILITY NUMBER: 376600812
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/02/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101212(b)

Reporting Requirements

(b) The name of the child care center director, and any fully qualified teacher(s) designated to act in the child care center director's absence, shall be reported to the Department within 10 days of a change of child care center director or designee(s). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the facility did not comply with the section cited above as the new site director that was hired in 09/2021 was not reported to the department, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/31/2022
	Plan of Correction
1 2 3 4	Facility representative stated she will provide a complete directors packet for the new site director. LPA provided a checklist with the needed licensing documents for the directors’ packet. In addition, a written plan of operation to ensure new site directors/principles are reported to the licensing within 10 days of the change. Plan of correction shall be submitted to the department by 03/31/22.

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: 03/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2022

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: LEMON GROVE SCHOOL DISTRICT-MOUNT VERNON PRESCHOOL	FACILITY NUMBER: 376600812
	VISIT DATE: 03/02/2022

NARRATIVE

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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 provides Incidental Medical Services (IMS). No children currently in care receiving IMS services. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

Please provide the updated licensing forms to the department by March 18, 2020:
· LIC610 – Emergency Disaster Plan. Ensure two relocation sites are listed on the form.
· LIC999 – Facility indoor and outdoor sketch

Facility was issued one type B deficiency during today’s inspection. The following reports were reviewed with the facility representative, Melvetta Owens. A notice of site visit was given and must remain posted for 30 days from today's date. Exit interview conducted with Melvetta Owens.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2022

LIC809 (FAS) - (06/04)

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