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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701348
Report Date: 01/06/2023
Date Signed: 01/06/2023 02:56:32 PM


Document Has Been Signed on 01/06/2023 02:56 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:POWAY COUNTRY PRESCHOOL INFANTFACILITY NUMBER:
376701348
ADMINISTRATOR:DAWN EMIKO RODRIGUEZFACILITY TYPE:
830
ADDRESS:14411 NORWALK LANETELEPHONE:
(858) 486-4420
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:16CENSUS: 10DATE:
01/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Dawn Emiko RodrigquezTIME COMPLETED:
03:30 PM
NARRATIVE
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On 1/6/23 at 12:30pm, Licensing Program Analyst, Patrick Ma, met with Director Dawn Emiko Rodriguez for the purpose of an unannounced annual inspection. There were 10 infants present with 3 teachers in 2 rooms. Facility is within ratio and capacity. Program operates M – F from 7:30 – 5:30pm.

LPA toured the facility. The rooms were clean, orderly and a comfortable temperature during this visit. Adequate ventilation and heating are available. All required forms were posted. The furniture, books, games and toys are safe, age-appropriate and in good repair. There is a variety of activities provided throughout the day. Infant foods/beverages are labeled/dated and stored per regulation in the infant room refrigerator. All meals and snacks are provided by the parents. Staff preparing food are using proper personal hygiene and food service practices. The food meets the nutritional requirements per regulation and proper quantity. Food has been stored separately from any chemicals or cleaning products and food preparation sink is separate from diaper/changing and toilet/potty chair hand washing sink.

Infant bedding/napping equipment is in good repair with standard cribs and mattresses of a water-resistant material, disinfected daily. Cribs are spaced adequately apart to meet regulation and are not blocking an entrance or an exit. Tight fitting crib sheets are in place, bedding is stored separately, and each child has his/her own. No children are using the same crib. Soiled sheets are kept inaccessible to children and bedding is washed daily or more if necessary. Infant changing tables have padded, washable vinyl at least one inch thick with sides raised at least 3 inches, per regulation and are within arm’s reach of a sink that is not used for food preparation. The changing table is disinfected between each use. Hand washing and toileting areas are in a safe, sanitary and operating condition. There is at least one potty chair or toilet with training seat present for every 5 infants who are potty training. All storage containers or trash cans containing solid or diaper waste have tight fitting lids and are in good repair. Any waste water used to clean is being discarded after use.
SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Patrick MaTELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:
DATE: 01/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/06/2023
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 01/06/2023 02:56 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: POWAY COUNTRY PRESCHOOL INFANT

FACILITY NUMBER: 376701348

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 01/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on file review, 3 out 4 staff files (S1 - S3) were missing current Mandated Reporter Training certificates which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/20/2023
Plan of Correction
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Director stated, staff will complete an updated Mandated Reporter Training and provide the Department proof of completion by 1/20/23.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Patrick MaTELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:
DATE: 01/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/06/2023
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: POWAY COUNTRY PRESCHOOL INFANT
FACILITY NUMBER: 376701348
VISIT DATE: 01/06/2023
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Each infant is to be under direct visual observation and supervision by staff at all times. If the napping area does not have a half or transparent wall that allows for audio and visual supervision from the activity area, staff is present in the napping area. Sleep checks are conducted and documented every 15 minutes for all infants. Appropriate supervision was in place during this visit.

The outdoor activity space is fully fenced and separate from other programs with age appropriate play equipment., securely anchored to the ground. There is sufficient cushioning and adequate shade. Drinking water is available at all times, both inside and outside. There are several staff present with current CPR and First Aid certification. Medications are stored in a lockbox above the refrigerator, inaccessible to children with all required documentation in place. There is no evidence of rodent or insect activity. The carbon monoxide detector is operational. The facility has a written disaster plan in place that meets regulatory requirement and has been conducting and documenting evacuation drills every six months. The facility does not transport children.

LPA reviewed sign in/out sheets, a sample of personnel records and a sample of children's records. 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.

Children are evaluated upon entry and monitored throughout the day for signs of illness. The isolation area for ill children awaiting pick up is the director’s office. The facility understand that current County requirements strongly recommend that all staff regardless of vaccination, wear masks while indoors. Reporting requirements for positive Covid-19 results in children or staff were discussed to include contact with County Department of Public Health for guidance (619-692-8499) and Licensing (619-767-2248) to report the unusual incident.

LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Patrick MaTELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023
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: POWAY COUNTRY PRESCHOOL INFANT
FACILITY NUMBER: 376701348
VISIT DATE: 01/06/2023
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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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 . Services are/are not in place today

Facility representative 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.

Licensee 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.”

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/inspection-process.

See LIC 809D for deficiencies cited.

Exit interview conducted and report was reviewed with the facility representative Dawn Emiko Rodriquez. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Patrick MaTELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023
LIC809 (FAS) - (06/04)
Page: 6 of 6