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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374844882
Report Date: 03/30/2022
Date Signed: 03/30/2022 11:19:17 AM

Document Has Been Signed on 03/30/2022 11:19 AM - 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:LEAPS AND BOUNDSFACILITY NUMBER:
374844882
ADMINISTRATOR:LORI HASKELLFACILITY TYPE:
850
ADDRESS:270 WEST CREST STREETTELEPHONE:
(760) 480-9787
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY: 66TOTAL ENROLLED CHILDREN: 54CENSUS: 31DATE:
03/30/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:37 AM
MET WITH:Sarah Kornijczuk, DirectorTIME COMPLETED:
11:24 AM
NARRATIVE
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On March 30, 2022 at 10:38 AM, Licensing Program Analysts (LPAs) Cindy Hamilton and Anastasia Flores arrived unannounced at the facility to conduct a Case Management inspection. Upon entering, LPAs conducted a COVID-19 pre-screening of the facility. LPAs met with Director Sarah Kornniczuk (DIR) and informed her of the purpose for the visit. A tour of the facility was conducted, census was taken and the Director interviewed.

On March 23, 2022, Community Care Licensing (CCL) received information stating the facility had been advised by a parent that an enrolled child had Pinworms during the prior two weeks and it was unclear if the facility had notified parents of the possible Pinworm exposure. On March 28, 2022, LPA Hamilton briefly spoke with DIR regarding possible exposure and DIR advised LPA that parents had been notified via a posting at the sign-in area. DIR also advised LPA Hamilton that no emails or telephone calls were made to parent to advise a child enrolled at the facility in fact had Pinworm and no other children were affected. LPA requested a copy of the notification that was provided to parents be sent to LPA via email. The DIR stated via email that notification was posted at the facility’s sign-in area from March 14-24, 2022 and provided a copy of the notification. The notification received via email from DIR consisted of general information regarding Pinworm infection from an internet website and no indication that the facility was possibly exposed to Pinworm. LPA Hamilton also reviewed the Department’s Unusual Incident Report (UIR) Log and CCL has not received a UIR as of this date. During the visit LPAs discussed with DIR the reporting requirements set forth per Title 22 and the facility’s responsibility of informing parents, staff and CCL of unusual incidents concerning the facility to ensure the health and safety of staff and children in care.

Based on document review and interviews, the facility is being cited for violation of Title 22, Division 12, Section 101212(f) and 101212(d)(1)(C ) Reporting Requirements. The facility did not properly inform parents or CCL of possible Pinworm exposure at the facility which poses a potential health, safety or personal rights risk to children in care.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Cindy Hamilton
LICENSING EVALUATOR SIGNATURE: DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/30/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: LEAPS AND BOUNDS
FACILITY NUMBER: 374844882
VISIT DATE: 03/30/2022
NARRATIVE
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An exit interview was conducted, a copy of this report along with Appeal Rights and a Notice of Site visit was provided to the Director. Prior to LPAs leaving the facility the Director posted the Notice of Site Visit in a visible area and the Director was reminded that the notice is to be posted for 30 days.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Cindy Hamilton
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
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Document Has Been Signed on 03/30/2022 11:19 AM - It Cannot Be Edited


Created By: Cindy Hamilton On 03/30/2022 at 10:56 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
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: LEAPS AND BOUNDS
FACILITY NUMBER: 374844882

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/30/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/12/2022
Section Cited
CCR
101212(d)(1)(C)

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101212(d)(1)(C) Reporting Requirements
(d) Upon the occurrence, during the operation of the child care center...a report shall be made to the Department ...Department's next working day and during its normal business hours. In addition, a written report…shall be submitted...within seven days...of such event.(1) Events reported shall include the following: (C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child. This requirement was not as evidenced by:
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Director has agreed to complete an Unusual Incident Report regarding possible exposure and to report all unusual incidents to CCL as required per Title 22. Director will also provide training to staff regarding reporting requirements. Director will provide proof of training (sign-sheet and training content) to LPA via email on or before POC date April 12, 2022
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Based on record review and interview the facility did not report to CCL a possible Pinworm exposure at the facility on or around March 14, 2022 which poses a potential health, safety, or personal rights risk to persons in care.
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Type B
04/05/2022
Section Cited
CCR101212(f)

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101212(f) Reporting Requirements
(f) The items specified in (d)(1)(A) through (H) above shall also be reported to the child's authorized representative. This requirement was not met as evidenced by:
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Director has agreed to provide notification to enrolled parents of possible Pinworm exposure on or around March 14, 2022. Director is to provide LPA with a copy the notification to parents via email on or before POC date of April 5, 2022.
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Based on record review and interview the facility did not provide proper notification/information to the parents of enrolled children regarding a possible Pinworm exposure at the facility on or around March 14, 2022 which poses a potential health, safety, or personal rights risk to persons 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:Carlos Martinez
LICENSING EVALUATOR NAME:Cindy Hamilton
LICENSING EVALUATOR SIGNATURE:
DATE: 03/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2022


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