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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701135
Report Date: 11/30/2021
Date Signed: 11/30/2021 01:42:02 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:CORONADO BAPTIST INFANT CAREFACILITY NUMBER:
376701135
ADMINISTRATOR:PRYSOCK, MARTHAFACILITY TYPE:
830
ADDRESS:111 ORANGE AVENUETELEPHONE:
(619) 435-8121
CITY:CORONADOSTATE: CAZIP CODE:
92118
CAPACITY:24CENSUS: 24DATE:
11/30/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:John Roamer, PastorTIME COMPLETED:
12:00 PM
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On 11/30/2021 at 11:00 a.m., Licensing Program Analyst (LPA), Michelle Hood arrived to conduct an unannounced Plan of Correction (POC) inspection for a deficiency cited on 11/18/2021. Upon arrival, LPA met with staff Stephanie Vargas and toured the facility. There were 12 infants with three staff present in classroom #1 and 12 infants with three staff on the playground from classroom #2. Around 11:45 a.m., Pastor John Roamer arrived to the facility.

On 11/19/2021, LPA received a copy via email of the new Covid-19/Ouch report. On this date, LPA observed 24 infants not displaying a runny nose or cough. The LIC 9224 forms were not available for review. LPA observed the Notice of Site - LIC 9213 posted from the inspection on 11/19/2021 on the wall in the lobby.

The Pastor was provided appeal rights (LIC9058 01/16) and their signature on this form acknowledges receipt of these rights. LPA provided the Notice of Site Visit - LIC 9213 and observed the Pastor post the LIC 9213. No deficiencies cited. An exit interview was conducted with Pastor John Roamer.
SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Michelle HoodTELEPHONE: (691) 767-2241
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2021
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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