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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701424
Report Date: 02/06/2020
Date Signed: 02/06/2020 11:38:27 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:GOOD SHEPHERD CATHOLIC SCHOOLFACILITY NUMBER:
376701424
ADMINISTRATOR:DESIREE FAJOTAFACILITY TYPE:
830
ADDRESS:8180 GOLD COAST DRIVETELEPHONE:
(858) 490-8200
CITY:SAN DIEGOSTATE: CAZIP CODE:
92126
CAPACITY:19CENSUS: 15DATE:
02/06/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Desiree FajotaTIME COMPLETED:
11:50 AM
NARRATIVE
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Licensing Program Analysts (LPA) Nancy Diaz and Tresha Souza conducted an unannounced case management inspection. LPAs met and toured the classrooms with Desiree Fajota, Site Director. Observed present in the infant classroom were 15 infants and toddlers.

Childrens' files were reviewed today. Type B deficiency was cited today. Type B deficiency if not corrected poses a potential risk to the health, safety or personal rights of children in care.

An exit interview was conducted with Ms. Fajota. Appeal rights were provided in writing.

LPA observed the Representative post the Notice of Site Visit in a prominent place. The Representative states it is understood that this notice must be posted for 30 days.

CONTINUED ON PAGE 2
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2020
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: GOOD SHEPHERD CATHOLIC SCHOOL
FACILITY NUMBER: 376701424
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/06/2020
Section Cited

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Toddler Component in an Infant Care Center.
Licensees serving infants may create a special program component for children who are between 18 months and 36 months of age. The provisions of Sections 101151 through 101239.2 and 101351 through 101439.1 shall apply to infant care centers operating a toddler component in addition to those specified in Health and Safety Code section 1596.956.
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This regulation requirement was not met as evidenced by LPAs' observation and review of children's files. During the tour of the infant room, LPAs observed 3 children under the age of 18 months in the toddler option group.
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She will create a "mobile" and "non-mobile" groups in the infant room.

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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: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:
DATE: 02/06/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2020
LIC809 (FAS) - (06/04)
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