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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701097
Report Date: 12/13/2022
Date Signed: 12/13/2022 01:43:53 PM


Document Has Been Signed on 12/13/2022 01:43 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:MARILLA-LAKESIDE EARLY ADVANTAGE PRESCHOOLFACILITY NUMBER:
376701097
ADMINISTRATOR:ROBYN BOWMANFACILITY TYPE:
850
ADDRESS:9745 MARILLA DRIVETELEPHONE:
(619) 390-2391
CITY:LAKESIDESTATE: CAZIP CODE:
92040
CAPACITY:97CENSUS: 34DATE:
12/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Robyn BowmanTIME COMPLETED:
02:00 PM
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On December 13, 2022 at 9:00 a.m. Licensing Program Analyst (LPA) Leilani Curtis visited the facility to conduct an annual inspection. Upon arrival LPA met with director Robyn Bowman and proceeded to tour the facility. LPA provided the LIC 125, Entrance Checklist to the director. Also present were a total of 34 children with 6 staff members. This is a Title 5 program. The director states that room #3 is not longer in use by the child care. The Lakeside Union School District has been using room #3 since 8/2022 for a special education program. The licensee will submit an application for a decrease of capacity and removal of room #3 from the license.

Appropriate ratios and capacity were observed. Furniture and age appropriate equipment is in good condition indoors and outdoors. Children's toilets and hand washing facilities are sanitary. Rooms are safe and clean. Food preparation area is clean, food and beverages are stored in covered containers at 45 degrees F or less if required, and storage containers for solid waste are covered. Drinking water is readily accessible inside and outside the classroom. All disinfectants, cleaning solutions, and other hazardous items are inaccessible to children through latches and locks. Storage area for poisons is locked. Medications are kept in a safe place inaccessible to children. The outdoor play area is fenced. Playground equipment is in safe condition, free of sharp, loose or pointed parts. The areas around or under high climbing equipment, swings, slides, and similar equipment is cushioned with material that absorbs a fall. The outdoor play area has canopies used for shade. There are no bodies of water or weapons at this facility. Fire drills are being conducted every 6 months. The facility does not maintain an operational carbon monoxide detector. Menus are posted.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:
DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2022
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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Document Has Been Signed on 12/13/2022 01:43 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: MARILLA-LAKESIDE EARLY ADVANTAGE PRESCHOOL
FACILITY NUMBER: 376701097

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/13/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.954
Licensure Requirements
Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and the director's statement, the licensee did not comply with the section cited above. The facility does not maintain an operational carbon monoxide detector. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/16/2022
Plan of Correction
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The director states that she will install an operational carbon monoxide detector. The director will send LPA a video of the carbon monoxide detector operating via email by 12/16/22.
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 4 out of 7 staff files reviewed did not contain verification of immunization against pertussis. One staff member was missing verification of immunization to measles. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/13/2023
Plan of Correction
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The director states that she will submit verification of the required immunization's to LPA via email by 01/13/23.
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: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:
DATE: 12/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2022
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: MARILLA-LAKESIDE EARLY ADVANTAGE PRESCHOOL
FACILITY NUMBER: 376701097
VISIT DATE: 12/13/2022
NARRATIVE
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This facility provides Incidental Medical Services – IMS. LPA reviewed children’s, personnel, and administrative records. The director states that one child brings an Epi-Pen to and from the facility when present. This child was not present during the inspection. 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. The director will submit an Incidental Medical Services Plan of Operation to LPA via email by 01/13/23.

Admission agreement, emergency information and medical assessment forms were reviewed for some children. First Aid/CPR certifications were reviewed and are in compliance. Sign in/sign out sheets are well maintained. Staff records contain documentation of education, training, and/or experience. Two staff members do not have completed criminal record statements, LIC508 on file. Staff members have completed Mandated Child Abuse Reporting, AB 1432. LPA advised the director that Mandated Reporter Certification must meet the requirements of AB1207. Some staff members do not have verification of the required immunization's at the facility.

LPA reviewed the following with Director Bowman: California Department of Public Health Covid-19 Guidance for Child Care Providers and Programs dated 10/21/22. LPA obtained an updated Emergency Disaster Plan for Child Care Centers- LIC610A, Personnel Report-LIC500, Administrative Organization, LIC309 and Parent Handbook.

See LIC809D for cited deficiencies.

SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022
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: MARILLA-LAKESIDE EARLY ADVANTAGE PRESCHOOL
FACILITY NUMBER: 376701097
VISIT DATE: 12/13/2022
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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.

Director Bowman 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.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Director Bowman.

SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 12/13/2022 01:43 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: MARILLA-LAKESIDE EARLY ADVANTAGE PRESCHOOL
FACILITY NUMBER: 376701097

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/13/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101237(a)
(a) Prior to construction or alterations, the licensee shall notify the Department of the proposed change(s).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and the director's statement, the licensee did not comply with the section cited above. The licensee has removed room #3 from the licensed facility and is using the room for a separate program through the school district. The licensee did not notify the Department before the change was made. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/30/2022
Plan of Correction
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The director states that she will have the licensee submit an application and letter requesting a decrease of capacity and room removal to the regional office by 12/30/22.
Type B
Section Cited
CCR
101170(d)
101170 Criminal Record Clearance
(d) All individuals subject to criminal record review shall, be fingerprinted and sign a Criminal Record Statement (LIC 508 [Rev. 1/03]) under penalty of perjury.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and Director's statement, the licensee did not comply with the section cited above in two out of seven staff files reviewed did not contain a criminal record statement, LIC508. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/16/2022
Plan of Correction
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The director states that she will submit a completed and signed Criminal Record Statement, LIC508 for the two staff members who did not have the document to LPA via email by 12/16/22.
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: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:
DATE: 12/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2022
LIC809 (FAS) - (06/04)
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