376700391-6-18-2019-51-CC-VWIN-BD9RR2-20190618131424

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376700391
Report Date: 06/18/2019
Date Signed: 06/18/2019 01:14:30 PM

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:	CAJON VALLEY STATE PRESCHOOL-JAMACHA		FACILITY NUMBER:	376700391
ADMINISTRATOR:	SKUBE, KATHRYN		FACILITY TYPE:	850
ADDRESS:	2962 JAMUL DRIVE		TELEPHONE:	(619) 441-6150
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92019
CAPACITY:	24	CENSUS: 0	DATE:	06/18/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Ann Hale		TIME COMPLETED:	01:25 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	Licensing Program Analyst Vicky Williamson conducted an annual random inspection. LPA met with teacher Ann Hale. The facility operates Monday - Friday from 8:30 am to 11:30 am. The indoor and outdoor of the facility was inspected. There were no children present during today's inspection. The classrooms and restrooms have adequate lighting, heating, and ventilation. Facility has a shared bathroom waiver on file. All floors appeared to be safe and clean. Furniture, children's cubbies and toys appeared to be in good condition. Trash cans have a tight-fitting covers and are in good repair. Disinfectants, cleaning solutions and other hazardous items are stored behind latched cabinets. Children are provided breakfast by the school district. Menu is posted monthly. Sign in/sign out sheets were reviewed and show parent/guardian’s signature and time of day recorded. The storage areas appeared to be clean. Facility appeared to be free of flies, other insects and rodents. The surface of the outdoor activity space is maintained in a safe condition with sufficient shade. Drinking water is 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 documented on 6/10/19. The school campus nurse's office is designated for use by children who are ill. A sample of children records, including medical assessment and emergency information were reviewed. Staff's records, including transcripts, teacher qualifications and experiences were reviewed. Opening and closing staff members have current CPR and First Aid certifications. Staff caregiver background checks, criminal record and child abuse index clearances or exemptions are verified through the Cajon Valley School District.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Vicky Williamson	TELEPHONE: (619) 767-2214
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2019

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: CAJON VALLEY STATE PRESCHOOL-JAMACHA	FACILITY NUMBER: 376700391
	VISIT DATE: 06/18/2019

NARRATIVE

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This facility provides Incidental Medical Services – IMS. LPA reviewed 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

Ann Hale stated that Jamacha Elementary School nurse provides IMS services to the children and medication is storage in the nurses office.

LPA and Ann Hale discussed reporting requirements, record keeping and sign in / sign out requirements. Ann Hale was provided information on the Effects of Lead Exposure.

To access our Regulation and Forms please use our WEBSITE: http://ccld.ca.gov

Please update and submit forms LIC 308, LIC 309, and Plan of Operation to the Licensing Agency by June 28, 2019.

No deficiencies cited during today's inspection. Facility was provided a copy of the appeal rights form LIC 9058 and the signature on this form acknowledges receipt of these rights.
The Notice of Site Visit (LIC 9213) was provided to be posted at the facility for 30 days. LPA observed form LIC 9213 posted.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Vicky Williamson	TELEPHONE: (619) 767-2214
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2019

LIC809 (FAS) - (06/04)

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