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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701328
Report Date: 11/20/2020
Date Signed: 12/09/2020 07:43:17 AM

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:RISING STAR PRESCHOOLFACILITY NUMBER:
376701328
ADMINISTRATOR:SANDRA RAYESFACILITY TYPE:
830
ADDRESS:3054 FAIRMOUNT AVENUETELEPHONE:
(619) 213-9356
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY:18CENSUS: 7DATE:
11/20/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:38 PM
MET WITH:Ashley Hofman TIME COMPLETED:
05:30 PM
NARRATIVE
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On 11/20/20 at 3:38 p.m., Licensing Program Analyst( LPA), Casey Gulley conducted a case management deficiency tele-inspection. During visit LPA met with Ashley Hofman and proceeded to virtually tour the facility. There were 7 children in care at time of visit. Facility operates Monday through Friday from 6:30 a.m. to 5:30 p.m.

Based on review of children attendance records, staff time reports, and staff interviews, it has been determined on at least one occasion on August 4, 2020, one staff member cared for five(5) infants for up to ten (10) minutes.

Facility was cited one type A deficiency during today's visit ( see same day 809-D) citation page). An exit interview was conducted with Ashley Hofman LPA discussed and will provide the following to licensee via email: LOC 809, LIC 809-D, appeal rights ( LIC 9058) and Notice of Site Visit( LIC 9213). LPA informed licensee LIC 9213 shall be posted for 30 days from today's date. COVID-19 State of emergency read receipt notification will be used in place of licensees' signature.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Casey GulleyTELEPHONE: (619) 767-2216
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2020
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: RISING STAR PRESCHOOL
FACILITY NUMBER: 376701328
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/20/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/20/2020
Section Cited

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Staff-Infant Ratio10416.5(b) There shall be a ratio of one teacher for every four infants in attendance.Requirement was not
met as evidenced by: Interviews conducted with staff indicating that the facility was operating out of ratio on multiple occasions in the month of August.
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This requirement is not met as evidenced based on: one staff member cared for 5 infants.Based on interviews and record reviews, the licensee did not ensure there was a ratio of one teacher observing and supervising no more than 5 children in care, which poses an immediate Health and Safety risk to 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: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Casey GulleyTELEPHONE: (619) 767-2216
LICENSING EVALUATOR SIGNATURE:
DATE: 11/20/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/20/2020
LIC809 (FAS) - (06/04)
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