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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372001274
Report Date: 06/14/2022
Date Signed: 06/14/2022 12:07:08 PM

Document Has Been Signed on 06/14/2022 12:07 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:LIFEBRIDGE PRESCHOOL & DAYCARE CENTERFACILITY NUMBER:
372001274
ADMINISTRATOR:JULIE HENDRICKSONFACILITY TYPE:
850
ADDRESS:17645 WEST BERNARDO DRIVETELEPHONE:
(858) 485-5933
CITY:SAN DIEGOSTATE: CAZIP CODE:
92127
CAPACITY: 142TOTAL ENROLLED CHILDREN: 174CENSUS: 131DATE:
06/14/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Julie HendricksonTIME COMPLETED:
12:15 PM
NARRATIVE
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On 06/14/2022 at 10:25am, Licensing Program Analyst (LPA), Selina Siao, conducted an unannounced case management inspection. LPA Siao conducted a tour of all the classrooms to gather census.

Facility was within staffing ratio during the inspection. One of the new staff member Deborah Bishop who has been working at the facility for about two weeks has the required background clearances but she is not associated to the facility. Therefore civil penalty of $500 will be assess today. See LIC809D for type B citation issue.


Appeal Rights (1/16) were discussed and provided. Notice of Site Visit was posted during this visit and will remain posted for 30 days.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE: DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/14/2022
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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Document Has Been Signed on 06/14/2022 12:07 PM - It Cannot Be Edited


Created By: Selina Siao On 06/14/2022 at 11:38 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: LIFEBRIDGE PRESCHOOL & DAYCARE CENTER
FACILITY NUMBER: 372001274

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/15/2022
Section Cited
CCR
101170(e)(2)

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Criminal Record Clearance
All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:
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Director stated she will be sure that a staff is associated to the facility prior to working.
Director will submit a written plan of correction to LPA no later than 06/15/2022.
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Request a transfer of a criminal record clearance as specified in Section 101170(f). This requirement was not met as staff Deborah Bishop has been working at the facility for two weeks and facility did not submit her background transfer to the licensing department. This poses a potential health and safety risk to clients 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:Monica Cuddy
LICENSING EVALUATOR NAME:Selina Siao
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2022


LIC809 (FAS) - (06/04)
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