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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701207
Report Date: 05/04/2022
Date Signed: 05/04/2022 02:41:02 PM


Document Has Been Signed on 05/04/2022 02:41 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:SAN DIEGO CHILDREN'S ACADEMYFACILITY NUMBER:
376701207
ADMINISTRATOR:NADEZDA GUSEVAFACILITY TYPE:
850
ADDRESS:801 GRAND AVENUE, SUITE 7TELEPHONE:
(619) 818-9522
CITY:SAN MARCOSSTATE: CAZIP CODE:
92078
CAPACITY:30CENSUS: 29DATE:
05/04/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Nadezda GusevaTIME COMPLETED:
02:50 PM
NARRATIVE
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On May 4, 2022 at 11:45 a.m. Licensing Program Analyst, Leilani Curtis, conducted an unannounced inspection to follow up on self-reported incidents which occurred on 4/14/22 and 4/18/22, wherein three children were diagnosed with salmonella infection. Upon arrival LPA met with director Nadezda Guseva and proceeded to tour the facility. There were 29 children with 4 staff members present. The children present were eating lunch. Appropriate ratio/capacity was observed. Staff member Yekaterina Konkova was not fingerprint cleared or associated to the facility. Ms. Konkova states that she has worked at the facility over three years. The director had a LiveScan receipt for Ms. Konkova dated 11/9/18 on file but the form did not include a facility number. LPA contacted the Community Care Licensing Regional Office to confirm that the staff member does not have a criminal record clearance.

LPA interviewed the director. The director’s daughter Anastasia Golopapenao translated for the director over the telephone. The licensee’s grand-daughter, Tatyana Yevstratenko was at the facility and also helped with translation. The director’s primary language is Russian. On 4/14/22 child #1 (C1) became ill and was diagnosed with salmonella infection. The facility was notified of the infection on 4/20/22. On 4/18/22 child #2 (C2) and child #3 (C3) became ill and were diagnosed with salmonella infection. The parents of C2 notified the facility on 4/22/22 and the parents of C3 notified the facility on 4/25/22. The director states that she has a license or “food handlers’ card” to prepare food. The director did not have a copy of the “food handlers’” card on site. She states that she will email a copy of the card to LPA by end of business today, 5/4/22. The director states that she cooks all meals at her home and brings them to the facility in either plastic or glass Tupperware containers. The food is stored in the facility refrigerator. The director states that she does not know how the children contracted salmonella. LPA toured the food preparation/storage area and observed it to be clean and free of hazards. LPA reviewed the contents of the facility refrigerator and observed that the director provides whole milk to the children in care. The director does not maintain current weekly menus at the facility. As a result of the salmonella diagnosis the director had the facility deep cleaned. Staff and children were notified to wash hands thoroughly and to stay home if they had signs of illness. The director notified the parents/guardians of the children in care of the salmonella outbreak. No new incidents have been reported. The staff members responded appropriately, and the parents were notified timely.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:
DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4


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: SAN DIEGO CHILDREN'S ACADEMY
FACILITY NUMBER: 376701207
VISIT DATE: 05/04/2022
NARRATIVE
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See LIC809D for cited deficiencies. A civil penalty has been assessed.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. A copy of the Fact Sheet - AB 633 Child Care Parent Notification Requirements and a copy of LIC 9224 was given to the director.

An exit interview was conducted with the director and appeal rights (LIC 9058 1/16) were discussed. The director’s signature on this form acknowledges receipt of these rights. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA observed the director post notice of site visit.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 05/04/2022 02:41 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: SAN DIEGO CHILDREN'S ACADEMY
FACILITY NUMBER: 376701207

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/05/2022
Section Cited

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Criminal Record Clearance: (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:(1) Obtain a California clearance or a criminal record exemption as required by the Department...This requirement was not met as evidenced by:
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Based on LPA's observation and record review staff member Yekaterina Konkova is not fingerprint cleared or associated to the facility. This poses an immediate health and safety risk to the children in care.
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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: 05/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4


Document Has Been Signed on 05/04/2022 02:41 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: SAN DIEGO CHILDREN'S ACADEMY
FACILITY NUMBER: 376701207

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/06/2022
Section Cited

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Food Services: (a) In child care centers providing meals to children, the following shall apply:(6) Menus shall be in writing and shall be posted at least one week in advance in an area accessible for review by the child's authorized representative. This requirement was not met as evidenced by:
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Based on LPA's record review and director's statement, the facility does not maintain or post current menu's. This poses a potential health and safety risk to children in care.
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Type B
05/06/2022
Section Cited

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1596.808 (a)(1): (a) Commencing January 1, 2012, except as provided in subdivisions (b) and (c), a licensed child day care facility shall comply with all of the following requirements for beverages served by the day care provider to children in the provider’s care:(1) Whenever milk is served, serve only lowfat (1 percent) milk or nonfat milk to children two years of age or older. This requirement was not met as evidenced by:
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Based on LPA observation the director serves whole milk to the children in care. This poses a potential health and safety risk to the children in care.
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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: 05/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4