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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372000300
Report Date: 04/04/2023
Date Signed: 04/04/2023 01:51:39 PM

Document Has Been Signed on 04/04/2023 01:51 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:KENSINGTON COMMUNITY CHURCH PRE-SCHOOLFACILITY NUMBER:
372000300
ADMINISTRATOR:ADRIANA DICARLOFACILITY TYPE:
850
ADDRESS:4773 MARLBOROUGH DRIVETELEPHONE:
(619) 280-1610
CITY:SAN DIEGOSTATE: CAZIP CODE:
92116
CAPACITY: 44TOTAL ENROLLED CHILDREN: 55CENSUS: 32DATE:
04/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Adriana DiCarloTIME COMPLETED:
11:00 AM
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On 4/4/23, at 8:50am, Licensing Program Analyst (LPA) Martha Malane, conducted an unannounced annual inspection and met with Director, Adriana DiCarlo. LPA disclosed the purpose of the inspection and was led on a tour of the facility. This is a half day program which operates on a traditional school year schedule. Days and hours of operation are Mon.–Fri 9:00am – 12:00pm and Mon,–Thurs, 12:00pm – 2:00pm for daycare. There were 32 children and seven (7) staff members present.

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. Areas around high climbing equipment and slides have rubber cushioning material to absorb falls. Toilets and hand-washing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe. 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 one or more functioning carbon monoxide detectors that meet statutory requirements. Parents provide snack from home.

Director stated there are no bodies of water on the premises. Director stated there are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions and other hazardous items are made inaccessible. No poisons were observed during the inspection.



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. 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. See LIC809C continuation...
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Martha Malane
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2023
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: KENSINGTON COMMUNITY CHURCH PRE-SCHOOL
FACILITY NUMBER: 372000300
VISIT DATE: 04/04/2023
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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. The name of the child care center director or fully qualified teacher designated to act in the director’s absence has been reported to the Department. 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.

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 ttps://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), Quarterly Updates, 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, no deficiencies cited. Exit interview conducted with Director, Adriana Dicarlo. 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.



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.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Martha Malane
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023
LIC809 (FAS) - (06/04)
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