376701424-9-8-2021-51-CC-TBLK-C6NSDM-20210908134724

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376701424
Report Date: 09/08/2021
Date Signed: 09/08/2021 01:47:35 PM

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 SCHOOL		FACILITY NUMBER:	376701424
ADMINISTRATOR:	DESIREE FAJOTA		FACILITY TYPE:	830
ADDRESS:	8180 GOLD COAST DRIVE		TELEPHONE:	(858) 490-8200
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92126
CAPACITY:	19	CENSUS: 13	DATE:	09/08/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:26 AM
MET WITH:	Desiree Fajota		TIME COMPLETED:	01:55 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	Licensing Program Analyst (LPA), Tyra Block and LPM, Monica Cuddy, visited the facility to conduct an annual inspection. Upon arrival LPA met with Desiree Fajota and proceeded to tour the facility. During today's inspection, there were 13 infants with 4 staff in the infant classroom. Appropriate ratios and capacity were observed. Appropriate care & visual supervision were also observed during the inspection while children were eating and on the mat for tummy time. Furniture and age appropriate equipment is available and in good condition. Rooms have adequate heating, lighting, and ventilation. There are no hazards accessible to children. Drinking water is readily accessible. An adequate supply of hand hygiene including soap and paper towels are available. Meals are brought from home labeled appropriately with name and date for each child. Cleaning supplies are kept separate from food and stored out of reach of children. Storage containers for solid waste have tight-fitting covers and are kept in good repair. The facility appears to be free of insects and rodents. There are no walkers, bouncy seats, exersaucers or jumpers in the room. High chairs or feeding tables have broad-based legs, plastic seats in good repair, and tray locked. Hazardous materials are inaccessible to children. Changing table has at least 1" padding covered with washable vinyl. Sides are a minimum of 3". The changing table is within arm's reach of sink. Caregivers are aware to wash hands before and after each feeding and each diaper change. Toys are safe, with no sharp edges, splinters or protruding points, nor small parts that can be pulled off and swallowed. Facility maintains individual feeding plans for each infant and has up-to-date Infant Needs and Services Plans for each infant on file. Cots are available for infants able to climb out of cribs. Cribs are available for younger infants. Bedding is identified and stored separately for each infant. Napping infants are under visual observation by staff. Sleeping plans and logs were discussed. Outdoor play area is a fenced playground with sufficient material for cushioning. There are no bodies of water or weapons at this facility. Trees on the infant playground provide shade to the area. All equipment is age appropriate. Drinking water is made available and grounds are free of debris or potential hazards.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Tyra Block	TELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021

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 2

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
	VISIT DATE: 09/08/2021

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
26
27
28
29
30
31
32

LPA reviewed sign-in/sign-out procedures and no child enrolled currently requires medication. Personnel records contain health screening and preventative health and safety training. Children’s records contain emergency information and medical assessments. At least one staff member has current CPR and First Aid certifications. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Staff immunization requirements were discussed. Infant center staff meet qualification requirements.

Incidental Medical services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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.

The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. LPA provided Notice of Site Visit and observed it being posted.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Tyra Block	TELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2