376700129-9-15-2022-20-CC-GGOZ-CJAT5J-20220915142538

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376700129
Report Date: 09/15/2022
Date Signed: 09/15/2022 02:25:51 PM

Document Has Been Signed on 09/15/2022 02:25 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:	CAMPO PRESCHOOL		FACILITY NUMBER:	376700129
ADMINISTRATOR:	CRYSTAL KREMENSKY		FACILITY TYPE:	850
ADDRESS:	1654 BUCKMAN SPRINGS ROAD		TELEPHONE:	(619) 473-9022
CITY:	CAMPO	STATE: CA	ZIP CODE:	91906
CAPACITY:	29	CENSUS: 23	DATE:	09/15/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Crystal Kremensky		TIME COMPLETED:	02:30 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 September 15, 2022, at 10:00 a.m., Licensing Program Analyst (LPA) Gloria Gonzalez, conducted an unannounced Annual Inspection and met with staff member, Veronica Findel. Director, Crystal Kremensky arrived at about 10:50 am. LPA disclosed the purpose of the inspection and toured the facility indoors and outdoors. This is a AM half day program which operates on a traditional school year schedule. Days and hours of operation are Monday-Friday from 9:00 am-12:30 pm. There is currently one classroom in operation. The following ratios were observed: Classroom #S1 (serves children age 3 through 5 years): There were 23 children present with 3 staff members in classroom S1. There is no swimming pool or other bodies of water on the premises. There are no firearms 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. 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.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Gloria Gonzalez	TELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022

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: CAMPO PRESCHOOL	FACILITY NUMBER: 376700129
	VISIT DATE: 09/15/2022

NARRATIVE

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A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Upon notification from the Department, the licensee will comply and act immediately to terminate the employment of, remove from the facility or bar from entering the facility for any person it is deemed necessary while the Department considers granting or denying an exemption.

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 name of the child care center director or fully-qualified teacher(s) 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. LPA reviewed a sample of staff files and observed files were not complete with health screening, report of child abuse, employee rights, personnel record, but did have immunization records for influenza, pertussis and measles and current documentation of completed mandated reporter training. Menus are posted at least one week in advance where an authorized representative can view them.

This facility does not provide Incidental Medical Services (IMS) at this time. Director 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.

LPA and Director discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, 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.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Gloria Gonzalez	TELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022

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: CAMPO PRESCHOOL	FACILITY NUMBER: 376700129
	VISIT DATE: 09/15/2022

NARRATIVE

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Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, deficiencies are being cited: (see next page, 809 D).

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.

A copy of the report and appeal rights (LIC 9058) was provided to the Director and notice of site visit (LIC9213) was given to Director and must remain posted for 30 days.

An exit interview conducted and report was reviewed with the Director, Crystal Kremensky.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Gloria Gonzalez	TELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022

LIC809 (FAS) - (06/04)

Page: 3 of 5

Document Has Been Signed on 09/15/2022 02:25 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: CAMPO PRESCHOOL	FACILITY NUMBER: 376700129
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/15/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(g)(2)

Personnel Requirements

(2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the Director did not comply with the section cited above in not having the health screening form on file for Staff #1 and #2 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/30/2022
	Plan of Correction
1 2 3 4	Director states she will send the health screening form for staff #1 and #2 to the department by 9/30/22.

Type B

Section Cited

CCR

101216(l)(1)(B)

Personnel Requirements

(B) A copy of the signed LIC 9052 (11/94) shall be kept in the employee's personnel record. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the Director did not comply with the section cited above in not having the employee rights in Staff #1 and #2 files, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/30/2022
	Plan of Correction
1 2 3 4	Director states she will send the employee rights form for staff #1 and #2 to the department by 9/30/22.

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: Gloria Gonzalez	TELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022

LIC809 (FAS) - (06/04)

Page: 4 of 5

Document Has Been Signed on 09/15/2022 02:25 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: CAMPO PRESCHOOL	FACILITY NUMBER: 376700129
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/15/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101217(a)(7)

Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (7) Past experience, including types of employment and former employers. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the Director did not comply with the section cited above in that Director did not ensure in having the personel record form for staff #1 and #2, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/30/2022
	Plan of Correction
1 2 3 4	Director states she will send the Personel Record form for staff #1 and #2 to the department by 9/30/22.

Section Cited

Personnel Records


	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: Gloria Gonzalez	TELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022

LIC809 (FAS) - (06/04)

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