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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701430
Report Date: 05/01/2023
Date Signed: 05/01/2023 12:02:31 PM


Document Has Been Signed on 05/01/2023 12:02 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:VILLAGE BLOOM CHILD DEVELOPMENT CENTERFACILITY NUMBER:
376701430
ADMINISTRATOR:PAULINE ASCUEFACILITY TYPE:
850
ADDRESS:448 RANCHO SANTA FE ROADTELEPHONE:
(760) 704-8314
CITY:ENCINITASSTATE: CAZIP CODE:
92024
CAPACITY:48CENSUS: 44DATE:
05/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Co-Director Kendra DeGrootTIME COMPLETED:
12:10 PM
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On 5/1/2023 at 9:10 a.m., Licensing Program Analyst (LPA), Joelle Redding, met with Co-Director, Kendra DeGroot, for the purpose of an unannounced annual inspection. There were 21 children present with three teachers in the Barn/Reading building (Sunflowers - PK); 11 children with two teachers in Room 1 (Poppy) and 12 children with two teachers teachers in Room 2 (Daisy). Facility is within ratio and capacity.

LPA toured the facility. The rooms were clean, orderly and a comfortable temperature during this visit. Adequate ventilation and heating are available. The furniture, books, games and toys are safe, age-appropriate and in good repair. There are a variety of activities available throughout the day. All required forms were posted. All storage containers and trashes containing solid waste have tight fitting lids and are in good repair. Children bring their own snack and lunch. Staff assisting with food are using proper personal hygiene and food service practices. Drinking water is readily available. Lead testing has not been done due to bottled water use. There is no napping in the program but there is a rest time after lunch. Most children leave at 1 p.m. Hand washing and toileting areas are in a safe, sanitary and operating condition. Any waste water used to clean is being discarded after use. Medications are kept in the office unless it is an epi-pen which is kept in the child's respective classroom, inaccessible to children. Poisons, disinfectants, cleaning solutions and other items that are dangerous to children have been made inaccessible. There is no evidence of rodent or insect activity. Each building has an attached fenced back and front patio along with the main playground and a small fenced side yard. Outdoor play areas are fully fenced with sufficient cushioning and adequate shade. Age appropriate playground equipment on the main playground and outdoor surfaces are in a safe condition with any equipment securely bolted to the ground. Portable water is used outdoors. There are no bodies of water, firearms or ammunition on the property. However, there is a pig enclosure at the rear of the main playground, separated from the slide area platform by a wooden and wire mesh fence with a locked gate under 5'. There is an approximately 2' x 3' water bowl with approximately 6-8" of standing water in the enclosure. Because the fencing is climbable, the area will need to be secured.
SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 05/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/01/2023
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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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: VILLAGE BLOOM CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 376701430
VISIT DATE: 05/01/2023
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THIS IS AN AMENDED VERSION OF THIS PAGE
In addition, there are several small pointed rocks around the landscape of the main playground and one large rock in the grassy area has similar characteristics. Due to the pointed areas of the rocks, they are a potential hazard should a child trip and fall into them while running or playing on the playground.

The carbon monoxide detector in each building 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 (Electronic via the Bright Wheel app), a sample of personnel records and a sample of children's records. There are several staff present with current CPR and First Aid certification. 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. Certificates on file are current.

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. 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 for three or more cases.

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 in place today.

Director 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.
SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: VILLAGE BLOOM CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 376701430
VISIT DATE: 05/01/2023
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Licensee is signed up for Quarterly Updates and Provider Information Notices (PINs) for one or more programs on our website: www.ccld.ca.gov.

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

LPA conducted child care quality management interview with Co-Director Kendra DeGroot. Exit interview conducted and report was reviewed with the Co-Director Kendra DeGroot.

Updated LIC 500 and LIC 610 were requested today.

See LIC 809D for Type B deficiencies.

NOTICE OF SITE VISIT WAS GIVEN AND WILL REMAIN POSTED FOR 30 DAYS. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 06/23/2023 02:07 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 05/03/2023 10:20 AM

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: VILLAGE BLOOM CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 376701430

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/01/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238(a)
Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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THIS IS AMENDED VERSION OF THE ORIGINAL DOCUMENT. Based on observation, there were several small rocks with pointy edges on the perimeter of the main playground and a larger rock in the grassy area with the same charachteristics. The pig enclosure contains a large water bowl and has climbable fencing under 5'. This poses a potential health, safety or personal rights risk to children in care.
POC Due Date: 05/26/2023
Plan of Correction
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Co-Director, Kendra DeGroot states that the fencing will be extended to 5' and wire mess will be placed in front of the board to prevent climbing. The small rocks will be removed and the large rock will be made inaccessible. Supervision will remain in place. Photos will be sent to LPA as verification of correction byt he plan of correction date.
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in [that Staff #1 did not have a TB test on file, current within 12 months prior to hire or 7 days after.This poses a potential health, safety or personal rights risk children in care.
POC Due Date: 05/26/2023
Plan of Correction
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Director states that she will have Staff #1 complete a TB test any required follow up by the plan of correction date and send proof to Licensing.
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: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4