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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372001274
Report Date: 02/03/2022
Date Signed: 02/24/2022 04:25:49 PM


Document Has Been Signed on 02/24/2022 04:25 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 02/24/2022 03:56 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

NARRATIVE
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This is an amended report.
On 2/3/22 Licensing Program Analyst Michael Morales-DeSilvestore conducted an unannounced case management inspection to verify compliance with the current indoor mask requirement due to COVID 19. LPA met with Teacher Nastassia Garcia who is in charge when Director Julie Hendrickson is out.

LPA toured the facility and observed the following:
Room 1: 2/12 children indoors wearing face covering - 1/1 staff (Rebecca Cummings) wearing face covering.
Room 2: 6/9 children indoors wearing face coverings - 0/1 staff (Anastasia Atkins) wearing face covering.
Room 3: 1/9 children indoors wearing face coverings - 0/1 staff (Linda Tillotson) wearing face covering.
Room 4: 0/6 children indoors wearing face coverings - 0/1 staff (Sara Salazar) wearing face covering.
Room 5: 13 children outdoors - Staff are Ashley Ortiz and Erica Jones
Room 6: 19 children outdoors - Staff are Amber Sanders and Michelle Jaquez
Kinder Room: 12 children outdoors - Staff is Nicole Castro

Facility had a total of 9/36 children indoors and 1/4 staff indoors following the current mask requirement. See attached LIC809D for cited deficiency and LIC421FC for assessed civil penalty for repeat violation.

SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Michael Morales-DeSilvestoreTELEPHONE: (619) 767-2208
LICENSING EVALUATOR SIGNATURE:
DATE: 02/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/24/2022
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 is an Amendment of Original Document on 02/24/2022 03:59 PM

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: LIFEBRIDGE PRESCHOOL & DAYCARE CENTER
FACILITY NUMBER: 372001274

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/04/2022
Section Cited

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101223 Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights:
(2) To be accorded safe, healthful and comfortable accommodations... This requirement was not met as evidenced by...
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Based upon LPA's observations 3 of 4 staff and 27 of 36 children are not wearing face coverings while indoors as required by California Department of Public Health. This creates an unsafe environment at the facility, which poses an immediate health and safety risk to children in care.
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Facility will submit proof of the parent letter, parent signed LIC9224's and signed statements from staff to the Department by 2/4/22.

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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: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Michael Morales-DeSilvestoreTELEPHONE: (619) 767-2208
LICENSING EVALUATOR SIGNATURE:
DATE: 02/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/24/2022
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: LIFEBRIDGE PRESCHOOL & DAYCARE CENTER
FACILITY NUMBER: 372001274
VISIT DATE: 02/03/2022
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An exit interview was conducted with Nastassia Garcia. LPA reviewed masking requirements with facility representative. A Notice of Site Visit (LIC9213) and Appeal Rights (LIC9058) were provided and signature on this form acknowledges receipt of these rights. LPA observed Notice of Site Visit being posted. Notice of Site Visit must remain posted for 30 days.

Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. Facility will also obtained signed LIC9224 Acknowledgement of Receipt of Licensing Reports for all currently enrolled children and newly enrolled children for the next 12 months.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Michael Morales-DeSilvestoreTELEPHONE: (619) 767-2208
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022
LIC809 (FAS) - (06/04)
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