376700096-9-20-2022-20-CC-MMAE-CJG5W6-20220920201837

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376700096
Report Date: 09/20/2022
Date Signed: 09/20/2022 08:18:51 PM

Document Has Been Signed on 09/20/2022 08:18 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:	ADAMS STATE PRESCHOOL		FACILITY NUMBER:	376700096
ADMINISTRATOR:	DECYDERED PINA		FACILITY TYPE:	850
ADDRESS:	4672 35TH STREET		TELEPHONE:	(619) 362-4200
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92116
CAPACITY:	24	CENSUS: 19	DATE:	09/20/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Virgie Glove		TIME COMPLETED:	01:00 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 9/20/22 at 10:00am, Licensing Program Analyst (LPA), Martha Malane conducted an unannounced annual inspection and met with Lead Teacher, Virgie Globe. LPA disclosed the purpose of the inspection and was led on a tour of the facility. This is an AM and PM program which operates on a traditional school year schedule. Days and hours of operation are Monday – Friday 8:55am-11:55am and 12:35pm-3:35pm. There were 19 children and four (4) staff members present. Lead teacher stated there are no bodies of water on the premises and LPA did not observe any bodies of water. Lead teacher stated 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. Furniture and equipment are in good condition. Playground equipment is in safe condition. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. Areas around high climbing equipment and swings have rubber matting for cushioning to absorb falls. Toilet and hand-washing equipment are in safe and sanitary operating condition. Floors in the facility are clean and safe. Solid waste storage containers do not have tight-fitting covers, Technical Assistance provided. Drinking water is available both indoors and outdoors. Facility has a functioning carbon monoxide detector. Facility staff have caregiver background checks through SDUSD. A review of staff records on this date indicates facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Lead Teacher was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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. See LIC809C continuation...

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha Malane	TELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

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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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: ADAMS STATE PRESCHOOL	FACILITY NUMBER: 376700096
	VISIT DATE: 09/20/2022

NARRATIVE

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Capacity and limitations as specified on the license are being maintained. At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at offsite activities. The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. 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. Facility staff did not have documentation of completed AB1207 mandated reporter training, see LIC809D for deficiency cited.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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.

LPA and lead teacher discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to California Megan’s Law (www.meganslaw.ca.gov), Lead Poisoning Facts and PIN 21-21-CCP: Lead Testing of Water in Licensed Child Care Centers Per AB 2370, Forms and Regulations.

Deficiencies were cited. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted with Lead Teacher, Virgie Globe.

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	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha Malane	TELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/20/2022 08:18 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: ADAMS STATE PRESCHOOL	FACILITY NUMBER: 376700096
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/20/2022

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 observation, interview and record review, the licensee did not comply with the section cited above in four (4) out of four (4) staff did not have current certification for AB1207 Mandated Reporter Training which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/21/2022
	Plan of Correction
1 2 3 4	Lead teacher stated she will submit proof of current certification for AB1207 Mandated Reporter Training for all staff members to CCL by 10/21/22 see mandatedreporterca.com.

Type B

Section Cited

CCR

101221(b)(8)(C)

Child's Records

(C) A signed consent form for emergency medical treatment unless the child's authorized representative has signed the statement specified in Section 101220(f). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in five (5) out of five (5) child files did not contain a signed consent form for emergency medical treatment which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/21/2022
	Plan of Correction
1 2 3 4	Lead teacher stated she will submit proof of a signed consent form for emergency medical treatment for C1, C2, C3, C4 and C5 to CCL by 10/21/22.

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: Martha Malane	TELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

LIC809 (FAS) - (06/04)

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