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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700164
Report Date: 06/07/2023
Date Signed: 06/07/2023 11:00:04 AM


Document Has Been Signed on 06/07/2023 11:00 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:BLOSSOM VALLEY ELEMENTARY SCHOOL PRESCHOOLFACILITY NUMBER:
376700164
ADMINISTRATOR:HOEBEN KIRKFACILITY TYPE:
850
ADDRESS:9863 OAKMONT TERRACETELEPHONE:
(619) 588-3678
CITY:EL CAJONSTATE: CAZIP CODE:
92021
CAPACITY:24CENSUS: 12DATE:
06/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Lead Teacher Kimberly GonzalesTIME COMPLETED:
11:10 AM
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On 6/7/2023 at 9:10 a.m., Licensing Program Analyst (LPA), Joelle Redding, met with Lead Teacher Kimberly Gonzalez, for the purpose of an unannounced annual inspection. There were 12 children present in classroom #25. Ms. Gonzalez is the only staff member and the elementary TK assistant teacher relieves her for her 15 minute breaks each day. This person is fingerprinted through the District but is not a fully qualified teacher under Licensing's regulations. Facility is not within ratio and capacity during this period of time. Ms. Gonzalez stated that this is the final year for this program and it will be closing at the end of the school year on June 15th.

LPA toured the facility. The room was clean, orderly and a comfortable temperature during this visit. Adequate ventilation and heating are available. The furniture, books, games and toys are safe, age-appropriate and in good repair. There are a variety of activities available throughout the day. All required forms were posted. All storage containers and trashes containing solid waste have tight fitting lids and are in good repair. There is cafeteria which is clean and sanitary. Food is stored in covered containers at 45 degrees or less and there is no expired or contaminated food present. Staff preparing food are using proper personal hygiene and food service practices. The food meets the nutritional requirements per regulation and is of good quality and proper quantity. The lunch/snack menu is posted, changes are recorded, and menus are stored for 30 days. Food has been stored separately from any chemicals or cleaning products. Drinking water is readily available. There is no napping in the program as it is part day.

Hand washing and toileting areas are in a safe, sanitary and operating condition. Any waste water used to clean is being discarded after use. Medications are kept in a locking file cabinet drawer, inaccessible to children. Poisons, disinfectants, cleaning solutions and other items that are dangerous to children have been made inaccessible. There is no evidence of rodent or insect activity. Outdoor play area is fully fenced with sufficient cushioning and adequate shade. Age appropriate playground equipment and outdoor surfaces are

SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2023
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: BLOSSOM VALLEY ELEMENTARY SCHOOL PRESCHOOL
FACILITY NUMBER: 376700164
VISIT DATE: 06/07/2023
NARRATIVE
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in a safe condition with any equipment securely bolted to the ground. However there is a large area of the cusioning under the swings that is indisrepair Portable water is used outdoors. There is no evidence of lead testing on file on or after January 1, 2020. There are no bodies of water, firearms or ammunition on the property. The carbon monoxide detector is operational.The facility has a written disaster plan in place that meets regulatory requirement and has been conducting and documenting evacuation drills every six months. The last drill was 5/26/23. The facility does not transport children. LPA reviewed sign in/out sheets, personnel records and a sample of children's records. Ms. Gonzales has current CPR and First Aid certification. Mandated Reporter training is completed through the District with a CCL approved program.

Children are evaluated upon entry and monitored throughout the day for signs of illness. The isolation area for ill children awaiting pick up is the nurse's office or a quiet area of the classroom or outdoors, depending on the illness. Reporting requirements for any communicable disease were discussed to include contact with County Department of Public Health for guidance (619-692-8499) and Licensing (619-767-2248) to report the unusual incident for three or more cases.



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. 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. Services are in place today. LPA did not an approved Incidental Medical Services Plan of Operation in place for this site but the majority of the Cajon Valley District Preschools do have them. LPA will contact Kathleen Cordero to discuss.

Ms. Gonzalez 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. All staff are fingerprinted through the school district.
SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
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: BLOSSOM VALLEY ELEMENTARY SCHOOL PRESCHOOL
FACILITY NUMBER: 376700164
VISIT DATE: 06/07/2023
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Licensee is signed up for Quarterly Updates and Provider Information Notices (PINs) for one or more programs on our website: www.ccld.ca.gov.

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
LPA conducted child care quality management interview with Ms. Gonzales. Exit interview conducted and report was reviewed with the Lead Teacher, Ms. Gonazles.

Type B deficiencies and a Technical Violation will be issued. See LIC 809 D for deficiencies and 9102A for Technical Violation.

NOTICE OF SITE VISIT WAS GIVEN AND WILL REMAIN POSTED FOR 30 DAYS. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 06/07/2023 11:00 AM - 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: BLOSSOM VALLEY ELEMENTARY SCHOOL PRESCHOOL
FACILITY NUMBER: 376700164

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on file review and interview with Ms. Gonzales, the licensee did not comply with the section cited above in that there is no evidence of the required lead testing on file for testing on or after January 1, 2020, which poses a potential health, safety or personal rights risk to children in care.
POC Due Date: 06/14/2023
Plan of Correction
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Ms. Gonzalez will provide this report to Kathleen Cordero, DIstrict Representative, for correction.
Type B
Section Cited
CCR
101216.3(b)(1)
Teacher-Child Ratio
(b) The licensee may use teacher aides in a teacher-child ratio of one teacher and one aide for every 15 children in attendance. (1) A ratio of one fully qualified teacher (as specified in Section 101216.1(c) and one aide for every 18 children in attendance in a preschool program is allowed when the aide meets the qualifications specified in Section 101216.2(d).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview with Ms. Gonzalez, the licensee did not comply with the section cited above in that they are using elementary school staff to supervise children during Ms.Gonzalez' 15 minute break. The staff is not teacher qualified under Title 22 regulation which poses a potential health, safety or personal rights risk to children in care.
POC Due Date: 06/14/2023
Plan of Correction
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Ms. Gonzalez will provide this report to Katheleen Cordero, District Representative, for correction.
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: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5


Document Has Been Signed on 06/07/2023 11:00 AM - 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: BLOSSOM VALLEY ELEMENTARY SCHOOL PRESCHOOL
FACILITY NUMBER: 376700164

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101239(n)
Fixtures, Furniture, Equipment and Supplies...Furniture and equipment shall be maintained in good condition, free of sharp, loose or pointed parts.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that the smaller slide on the play structure is cracked at the bottom and yields to weight causing the crack to increase during use and may cause injury to a child. This poses a potential health, safety or personal rights risk to children in care.
POC Due Date: 06/14/2023
Plan of Correction
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Ms. Gonzalez states that she has already reported this to the school office and will provide this report to Kathleen Cordero, District Representative, for correction. She supervises children to prevent injury in the meantime.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2023
LIC809 (FAS) - (06/04)
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