376105043-4-25-2022-51-CC-SCLA-CDTSJ7-20220425135439

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376105043
Report Date: 04/25/2022
Date Signed: 04/25/2022 01:54:48 PM

Document Has Been Signed on 04/25/2022 01:54 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:	AU CLAIR DE LUNE		FACILITY NUMBER:	376105043
ADMINISTRATOR:	ANNE LAURE PETIT		FACILITY TYPE:	850
ADDRESS:	1976-1978 COOLIDGE STREET		TELEPHONE:	(858) 384-6648
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92111
CAPACITY:	30	CENSUS: 23	DATE:	04/25/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Claire Hemery		TIME COMPLETED:	02:15 PM

NARRATIVE

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On 04/27/2021 at 11:45am, Licensing Program Analyst (LPA) Samantha Clenista conducted an annual inspection. Upon arrival, LPA met with Assistant Director, Claire Hemery and proceeded to tour the facility. LPA observed a total of 23 children with a total of 4 staff. Children were observed eating snack outside on the side courtyard. Appropriate capacity and ratio was observed during inspection.

All required notices, forms and licenses were posted. Furniture and age appropriate equipment is in good condition. Rooms have adequate heating, lighting and ventilation. Storage cubbies are readily available, and room accommodates class size. Napping equipment consists of cots which are kept in classroom and each cot has its own sheet or covering. Bathrooms are maintained with operational toilets and faucets with appropriate temperature. Paper towels and toilet paper are available. Bathroom is lighted and has ventilation. Food service area consists of a kitchen which is clean and free of hazards. Menu is posted. Adequate food is available for snacks. Cleaning supplies are kept up high or locked in cabinets and inaccessible to children. Outdoor play area is a fenced playground with sufficient cushioning (wood chips). LPA advised Ms. Hemery to have the staff rake the wood chips so that there is more cushioning near the areas were a child could fall. Areas have trees and canopies used for shade. Equipment is age appropriate. Each child brings their own water bottle from home and it is available for the children when they are inside and outside the classroom. The playgrounds are free of debris and potential hazards.

LPA reviewed electronic sign-in sheet via Procare and was observed to be in compliance. Isolation area is the Director's office. Staff and children records were reviewed. Children records were observed to be in compliance, however staff records were observed to be incomplete.

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha Clenista	TELEPHONE: (619) 818-6740
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2022

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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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: 04/25/2022

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All personnel have required criminal record and child abuse index clearances. Facility has an operating carbon monoxide detector located in the kitchen area. Ms. Hemery was reminded that corporal punishment and smoking are not allowed in day care.

This facility provides Incidental Medical Services – IMS, however, facility currently has no medications on site 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

Child Care Providers can now sign up for Quarterly Updates and PINS through the DSS website at https://cdss.ca.gov/inforesources/community-care-licensing/subscribe. LPA discussed California Megan's Law with provider and advised her to go on the website at www.meganslaw.ca.gov. 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

Ms. Hemery 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 809D for cited deficiency. Exit interview was conducted and report was reviewed with Ms. Hemery. A notice of site visit was given and must remain posted for 30 days. Failure to keep notice posted will result in a civil penalty of $100.00.

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha Clenista	TELEPHONE: (619) 818-6740
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/25/2022 01:54 PM - It Cannot Be Edited

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101217(d)

Personnel Records. All personnel records shall be maintained at the child care center and shall be available to the licensing agency for review. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA's file review of the facility's staff files, the licensee did not comply with the section cited above in due to all staff files missing several licensing forms and requirements in order for it to complete which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/13/2022
	Plan of Correction
1 2 3 4	LPA provided Ms. Hemery a master checklist of what needs to be in an employee file. Ms. Hemery stated she will gather all documents together and have all files completed no later than 05/13/2022. LPA will conduct a follow up inspection on a later date to ensure all staff files are complete.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha Clenista	TELEPHONE: (619) 818-6740
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2022

LIC809 (FAS) - (06/04)

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