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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701430
Report Date: 08/30/2021
Date Signed: 08/30/2021 03:11:21 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: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: 0DATE:
08/30/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Director Pauline AscueTIME COMPLETED:
03:15 PM
NARRATIVE
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On 8/30/21 at 1:30 p.m., Licensing Program Analyst, Joelle Redding, met with Director Pauline Ascue for the purpose of an unannounced annual inspection. During this visit, LPA also evaluated the facility's new playground space for use. No children were present for today's visit. The program will restart on 9/7/2021, 8 a.m. to 3 p.m. Monday thru Friday.

The Pre-K room (Barn) had a water leak and was currently undergoing repairs, due to finish this week. The Director will send photos once completed. LPA toured Rooms 1, 2 and the Library along with the playgrounds. The furniture, books, games and toys are safe, age-appropriate and in good repair. Rooms were a comfortable temperature during this visit. No hazards were noted. All storage containers and trashes have tight fitting lids and are in good repair. All food is brought from home including snacks. There is a kitchen which is in the staff room where emergency snacks are stored. Hand washing and toileting areas are in a safe, sanitary and operating condition. Medications are kept in the kitchen for Rooms 1 and 2 and in a higher cabinet in the Barn. Both areas are 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. Outdoor play areas are fully fenced with sufficient cushioning and adequate shade. The newly added playground will serve as outdoor space for Rooms 1 and 2 in addition to their concrete area. It is equipped with a large tree for shade, a rabbit hutch, wood chip cushioning, a small slide and a sand area covered by an awning, all fully fenced. Playground equipment and outdoor surfaces are in a safe condition No hazards were noted. Portable water is used outdoors. There are no bodies of water, firearms or ammunition on the property. The carbon monoxide detectors are operational.

Sign in/out is electronic and is printed at the end of the day, stored in binder for review. LPA reviewed a sample of personnel records for a health screening and on-the-job training. A sample of children's records for emergency information and a medical assessment. Children are evaluated upon entry and monitored
SUPERVISOR'S NAME: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021
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 3
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: 08/30/2021
NARRATIVE
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throughout the day for signs of illness. Covid precautions are in place and the facility understand that all children over the age of 2 years and all staff, regardless of vaccination, are required (under County order) to wear face covering inside. The isolation area for ill children awaiting pick up is the staff room or the office area. There is at least one staff present with current CPR and First Aid certification. All staff is going to be recertified with Heartsaver on Thursday, September 2nd. AB 1207 (Mandated Reporter Training) requirements have been met. 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.

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 not in place

Licensee is signed up for Quarterly Updates and Provider Information Notices (PINs) for one or more programs on our website: www.ccld.ca.gov.

See LIC 809D for Type B deficiency. Appeal Rights were discussed and provided. Signature at the bottom of this report confirms receipt.

Notice of Site Visit was posted and will remain posted for 30 days.
SUPERVISOR'S NAME: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: 08/30/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/27/2021
Section Cited

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Health and Safety Code. Commencing September 1, 2016, a person shall not be employed or volunteer at a...child care center... if he or she has not been immunized against influenza, pertussis, and measles or qualifies for an exemption. This requirement was not met as evidence by:
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Based on file review, Staff #1 and #2 did not have evidence of a Measles vaccination on file. This is a potential hazard to the health and safety of children in care.
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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 PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2021
LIC809 (FAS) - (06/04)
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