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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700303
Report Date: 09/30/2022
Date Signed: 09/30/2022 01:55:28 PM


Document Has Been Signed on 09/30/2022 01:55 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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108



FACILITY NAME:JOHNSON STATE PRESCHOOLFACILITY NUMBER:
376700303
ADMINISTRATOR:JENKINS-MARTIN, TRACEYFACILITY TYPE:
850
ADDRESS:1355 KELTON ROADTELEPHONE:
(619) 264-0103
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY:24CENSUS: 8DATE:
09/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Kim Barnes, Facility Representative TIME COMPLETED:
02:15 PM
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On 09/30/2022 at 11:25 am, Licensing Program Analyst (LPA), Michelle Hood, met with staff Kim Reels for the purpose of an unannounced annual inspection. There were eight children present with three teachers in K1 classroom. The facility is within ratio and capacity. The program operates an AM session 7:30 am to 10:30 am and a PM session 11:05 am to 2:05 pm. The facility license reads the preschool uses the K2 classroom for preschool children.

LPA toured the facility. The room is clean, orderly and at 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 is a variety of activities available throughout the day. All required forms were posted. All storage containers and trashes have tight-fitting lids and are in good repair. The kitchen 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 menu is posted, changes are recorded, and menus are stored for 30 days. Food has been stored separately from any chemicals or cleaning products. Meals are provided by the school's central cafeteria.

Hand washing and toileting areas are in safe, sanitary, and operating condition. Any waste water used to clean is discarded after use. Medications are kept, 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. The outdoor play area is fully fenced with sufficient cushioning and adequate shade, separate from other programs. Age-appropriate playground equipment and outdoor surfaces are in a safe condition with any equipment securely bolted to the ground. The children bring their water bottles to school. There are no bodies of water, firearms, or ammunition on the property. The facility has a written disaster plan in place that meets the regulatory requirement and has been conducting and documenting evacuation drills every six months. The facility does not transport children.

SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Michelle HoodTELEPHONE: (691) 767-2241
LICENSING EVALUATOR SIGNATURE:
DATE: 09/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2022
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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: JOHNSON STATE PRESCHOOL
FACILITY NUMBER: 376700303
VISIT DATE: 09/30/2022
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LPA reviewed sign-in/out sheets, a sample of personnel records, and a sample of children's records. There is at least one staff present with current CPR and First Aid certification. The facility is reminded the Mandated Reporter Training is to be retaken every two years and can be accessed at the following website: www.mandatedreporterca.com.

Children are evaluated upon entry and monitored throughout the day for signs of illness. The isolation area for ill children awaiting pick up is in the nurse's office. The facility has sufficient Personal Protective Equipment (PPE). Reporting requirements for positive Covid-19 results in children or staff were discussed to include contact with the County Department of Public Health for guidance (619-692-8499) and Licensing (619-767-2248) to report the unusual incident.

This facility does not provide Incidental Medical Services – IMS. LPA reviewed the storage of medication and equipment/supplies and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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/are not in place today

Facility representative Kim Barnes 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 the 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. Title V facility. All personnel have required criminal record and child abuse index clearances or exemptions through SDUSD.

The licensee is advised to sign up for Quarterly Updates and Provider Information Notices (PINs) for one or more programs on our website: www.ccld.ca.gov. Select “Child Care” then “Quick Links” and Quarterly Updates. Select “Receive Important Updates” then put the email address in and choose which program(s) you would like to subscribe to and select “Subscribe.”



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/n-process
SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Michelle HoodTELEPHONE: (691) 767-2241
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022
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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: JOHNSON STATE PRESCHOOL
FACILITY NUMBER: 376700303
VISIT DATE: 09/30/2022
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LPA conducted a child care quality management interview with Kim Barnes. An exit interview was conducted and the report was reviewed with the facility representative.

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: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Michelle HoodTELEPHONE: (691) 767-2241
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3