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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700719
Report Date: 11/03/2022
Date Signed: 11/03/2022 11:31:02 AM


Document Has Been Signed on 11/03/2022 11:31 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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108



FACILITY NAME:VIP VILLAGE STATE PRESCHOOL AT NICOLOFF ELEMENTARYFACILITY NUMBER:
376700719
ADMINISTRATOR:EVELIN MEDINAFACILITY TYPE:
850
ADDRESS:1777 HOWARD AVENUETELEPHONE:
(619) 628-8690
CITY:SAN YSIDROSTATE: CAZIP CODE:
92173
CAPACITY:48CENSUS: 28DATE:
11/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:David SheppardTIME COMPLETED:
11:45 AM
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On 10/07/2022 at 9:05 am, Licensing Program Analyst, Michelle Hood, met with Principal Evelin Medina for the purpose of an unannounced annual inspection. The facility custodian Juan Alatorre led LPA on the tour of the facility. Program operates an AM and PM session Monday through Friday from 8:15 am to 3:45 pm. Director, David Sheppard, arrived shortly. The following was observed:

Room 36 (Serves ages 3 to 5 years):
  • There were thirteen children present with two staff members
Room 37 (Serves ages 3 to 5 years works with head start program):
  • There were fifteen children present with two staff members
Appropriate ratios and capacity were observed.

The rooms were clean, orderly and at a comfortable temperature during this inspection. 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. Room 36 is with the state program and gets lunches through the school cafeteria. Room 37 is with the head start program and provides lunches and snacks from the school cafeteria. 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 online and in the classrooms. Food has been stored separately from any chemicals or cleaning products. Drinking water is readily available for the children.

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. Staff records of education, training, and/or experience will be reviewed at the HR office located at 601 Elm Ave, 91932.

SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Michelle HoodTELEPHONE: (619) 767-2241
LICENSING EVALUATOR SIGNATURE:
DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/03/2022
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: VIP VILLAGE STATE PRESCHOOL AT NICOLOFF ELEMENTARY
FACILITY NUMBER: 376700719
VISIT DATE: 11/03/2022
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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. 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 the regulatory requirement and has been conducting and documenting evacuation drills every six months. The facility does not transport children.

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 staff lounge. If there is a Covid concern the child will go to the school 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.



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

David Sheppard 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.

The director 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.”

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

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022
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: VIP VILLAGE STATE PRESCHOOL AT NICOLOFF ELEMENTARY
FACILITY NUMBER: 376700719
VISIT DATE: 11/03/2022
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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

ANNUAL CONTINUATION WILL BE DONE AT HUMAN RESOURCES OFFICE LOCATED AT 601 ELM AVE., 91932.

No deficiencies are cited at this time. 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.

LPA conducted a child care quality management interview with David Sheppard. An exit interview was conducted and the report was reviewed with David Sheppard

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

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022
LIC809 (FAS) - (06/04)
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