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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105043
Report Date: 03/30/2021
Date Signed: 03/30/2021 10:53:37 AM

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:AU CLAIR DE LUNEFACILITY NUMBER:
376105043
ADMINISTRATOR:ANNE LAURE PETITFACILITY TYPE:
850
ADDRESS:1978 COOLIDGE STREETTELEPHONE:
(858) 384-6648
CITY:SAN DIEGOSTATE: CAZIP CODE:
92111
CAPACITY:30CENSUS: 0DATE:
03/30/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Anne Laure Petit & Claire HemeryTIME COMPLETED:
11:00 AM
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On 03/29/2021 at 9:10am, Licensing Program Analyst (LPA), Samantha Salunga conducted an announced Pre-Licensing inspection. LPA met with Applicant, Anne Laure Petit and designated Site Director, Claire Hemery. The Preschool Program will operate Monday to Friday from 7:30am to 5:30pm in “Classroom.” Fire clearance was granted on 01/20/2021. Medications will be stored in a high cabinet located upon entrance to the right. Applicant has submitted and completed the COVID-19 self-assessment guide.

All indoor and outdoor activity space utilized for the children were inspected and measured today. The indoor play space measured at 1,101.27 sq. ft., which will accommodate the requested capacity of 30 children. The outdoor playground area measured at 4,701 sq. ft., which will accommodate no more than 62 children at one time. LPA observed the indoor play space to be complete with age-appropriate furniture and equipment, including tables, chairs, cubbies, napping cots, bookshelves, and other activity supplies for the children. There are 3 toilets which is sufficient for 45 children and two sinks which is sufficient for 30 children. Children are to be escorted and supervised by staff to and from the bathroom and under direct visual observation. There is a separate bathroom for staff located adjacent to the kitchen area, equipped with 1 toilet and 1 sink and is also designated for use by children who are ill. The Director's office will be the isolation area for children who are ill. There is a carbon monoxide detector located above the kitchen counter top. The kitchen area currently includes a microwave, refrigerator and water dispenser. Menus are posted upon entrance and throughout the classroom, as well as all other required documents for the parents and employees. Sign-in sheet is located upon entrance. Applicant was reminded to keep anything that reads, “Keep Out of Reach of Children” to be inaccessible to children.

LPA inspected the outdoor playground. Area has a big tree and canopies used for shade, age appropriate play equipment, and sufficient cushioning (wood chips) under the slides and climbing structure. Drinking water is readily accessible with portable drinking water from a water dispenser.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha SalungaTELEPHONE: (619) 767-2209
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2021
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: AU CLAIR DE LUNE
FACILITY NUMBER: 376105043
VISIT DATE: 03/30/2021
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This facility provides Incidental Medical Services – IMS (inhaler, nebulizer and epi-pen). There are no medications on site for LPA to review. 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

Applicant states she understands that all staff must have a criminal record clearance and be associated to the facility prior to having a presence in the Center. Child Care Providers can now sign up for Quarterly Updates and PINS through the DSS website. Please go to www.ccld.ca.gov and click on “Receive Important Updates,” then enter your email address and choose which program you would like to subscribe to and click subscribe. For any questions or to



Prior to licensure, the outdoor playground chain link fence facing west must meet at least 4 ft. high. LPA measured it to be 3ft. and 10 inches during inspection. Applicant stated she will provide LPA proof via pictures of correction no later than 04/09/2021.

Exit interview was conducted. A preschool license for 30 children may be granted upon final file review. The applicant was provided a copy of her appeal rights (LIC 9058 12/15) and her signature on this form acknowledges receipt of these rights. This report shall be kept available at the facility for public review for 3 years.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha SalungaTELEPHONE: (619) 767-2209
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2021
LIC809 (FAS) - (06/04)
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