376700009-8-26-2019-51-CC-MHOD-BFEMXQ-20190826100019

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376700009
Report Date: 08/26/2019
Date Signed: 08/26/2019 10:00:25 AM

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:	TSUMIKI		FACILITY NUMBER:	376700009
ADMINISTRATOR:	TAKAHASHI, MIHO		FACILITY TYPE:	850
ADDRESS:	4811 MT. ETNA DRIVE		TELEPHONE:	(858) 571-7000
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92117
CAPACITY:	40	CENSUS: 24	DATE:	08/26/2019
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Maasa Ishikawa, Teacher		TIME COMPLETED:	10:20 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	Licensing Program Analyst (LPA) Michelle Hood conducted a required inspection. The facility operates Monday - Friday from 7:00 am to 6:00 pm. The indoor and outdoor of the facility was inspected. There were 24 children present with 3 fully qualified teachers and 1 aide. The facility operates within licensed capacity and ratio limitations. Children were observed to be under visual supervision. The classroom and restrooms have adequate lighting, heating, and ventilation. All floors appeared to be safe and clean. Furniture, children's cubbies, toys and napping equipment (mats) appeared to be in good condition. Trash cans have tight-fitting covers. Disinfectants, cleaning solutions and other hazardous items are stored behind latched cabinets. Medication policies and procedures were reviewed. Menu is posted monthly in advance. All food was inspected and protected from contamination. Sign in/out sheets were reviewed showing parent/guardian’s signature and time of day recorded. The kitchen and storage areas appeared to be clean. The surface of the outdoor activity space is maintained in a safe condition with sufficient shade. Drinking water are available inside the classrooms and outdoor play area. There are no bodies of water and weapons present on the premises. The last fire drill was conducted on documented on 05/17/2019. The director's office is designated for use by children who are ill. A sample of the children's records, including medical assessment and identification & emergency information were reviewed. Staff's records and transcripts were reviewed to verify teacher qualifications and experiences. Opening and closing staff members have current CPR and First Aid certifications. A review of staff records on 08/26/2019, indicated that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (559) 243-4588
LICENSING EVALUATOR NAME: Michelle Hood	TELEPHONE: (619) 767-2241
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2019

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: TSUMIKI	FACILITY NUMBER: 376700009
	VISIT DATE: 08/26/2019

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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

Please update form LIC 308, LIC 309, board resolution, LIC 500, LIC 610 and staff's handbook to the Licensing Agency by 09/27/2019.

The Notice of Site Visit (LIC 9213) was provided to be posted at the facility for 30 days. LPA observed form LIC 9213 posted. An exit interview was conducted.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (559) 243-4588
LICENSING EVALUATOR NAME: Michelle Hood	TELEPHONE: (619) 767-2241
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2019

LIC809 (FAS) - (06/04)

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