376701365-4-12-2022-20-CC-MMAE-CDEQTC-20220412122655

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376701365
Report Date: 04/12/2022
Date Signed: 04/12/2022 12:27:04 PM

Document Has Been Signed on 04/12/2022 12:27 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:	LA PETITE ETOILE 360 PRESCHOOL		FACILITY NUMBER:	376701365
ADMINISTRATOR:	JENNIFER NELSON		FACILITY TYPE:	850
ADDRESS:	4555 PARK BOULEVARD		TELEPHONE:	(858) 449-4891
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92116
CAPACITY:	20	CENSUS: 17	DATE:	04/12/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Jennifer Nelson		TIME COMPLETED:	12:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 4/12/22, at 9:10am, Licensing Program Analyst (LPA) Martha Malane, conducted an unannounced Annual Inspection and met with Director, Jennifer Nelson. LPA disclosed the purpose of the inspection and toured the facility indoors and outdoors. Owner, Celine Theano arrived at the facility at 9:35am. This is a full day program which operates year-round. Days and hours of operation are Monday – Friday 8:00am – 5:00pm. There are currently three (3) classrooms in operation. There was a total of 17 children present with three (3) staff members outside during the inspection. Owner stated there are no bodies of water on the premises and LPA did not observe any bodies of water on the premises. Owner stated there are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. No poisons observed. Furniture and equipment are in good condition. Playground equipment is in safe condition The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. Toilets and hand-washing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe. Kitchen, food preparation and storage areas are clean. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors. Facility has a functioning carbon monoxide detector that met statutory requirements. Children bring snacks and lunch from home. A review of staff records on this date indicates facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Owner was reminded 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. See LIC809C continuation...

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha Malane	TELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022

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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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: LA PETITE ETOILE 360 PRESCHOOL	FACILITY NUMBER: 376701365
	VISIT DATE: 04/12/2022

NARRATIVE

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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. Capacity and limitations as specified on the license are being maintained. At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at offsite activities. The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. Children are under supervision, including visual supervision, of a teacher at all times. Facility maintains a ratio of one teacher supervising no more than 12 children in care. LPA reviewed a sample of children’s files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child and medical assessment. LPA reviewed a sample of staff files and observed files were complete with health screening, immunization records for influenza, pertussis and measles and current documentation of completed mandated reporter training.

This facility provides Incidental Medical Services (IMS). LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA and director discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Mandated Reporter Training, California Megan’s Law (www.meganslaw.ca.gov), Forms and Regulations.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D).

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

Exit interview conducted and report was reviewed with Owner, Celine Theano.

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.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha Malane	TELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/25/2022 07:45 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 04/21/2022 03:53 PM

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: LA PETITE ETOILE 360 PRESCHOOL	FACILITY NUMBER: 376701365
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/12/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101226(e)(3)(A)

Health-Related Services

(3) Prescription medications may be administered if all of the following conditions are met: (A) Prescription medications shall be administered in accordance with the label directions as prescribed by the child's physician. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above in one (1) out of two (2) prescription medications did not have label directions as prescribed by the child's physician which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/13/2022
	Plan of Correction
1 2 3 4	Owner stated she will send prof of medication for C1 with label directors as prescribed by the child's physician and a sign in sheet and agenda for training staff on proper handling of medication to CCL by 4/13/22.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha Malane	TELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022

LIC809 (FAS) - (06/04)

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