376105070-6-7-2023-51-CC-JREG-CSKTTY-20230607150131

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376105070
Report Date: 06/07/2023
Date Signed: 06/07/2023 03:01:41 PM

Document Has Been Signed on 06/07/2023 03:01 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:	CAJON VALLEY MADISON ELEMENTARY STATE PRESCHOOL		FACILITY NUMBER:	376105070
ADMINISTRATOR:	STEPHANIE DODDS		FACILITY TYPE:	850
ADDRESS:	1615 EAST MADISON AVENUE		TELEPHONE:	(619) 588-3077
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92019
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 22	DATE:	06/07/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	AM Lead Teacher Teresa Macias		TIME COMPLETED:	03:10 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 6/7/2023 at 1:30 p.m., Licensing Program Analyst (LPA), Joelle Redding, met with a.m. Lead Teacher Teresa Macias, for the purpose of an unannounced annual inspection. There were 22 children present with two teachers and two Assistants in Room 104. Facility is within ratio and capacity. LPA toured the facility. The room was clean, orderly and a comfortable temperature during this visit. Adequate ventilation and heating are available. The furniture, books, games and toys are safe, age-appropriate and in good repair. There are a variety of activities available throughout the day. All required forms were posted. All storage containers and trashes containing solid waste have tight fitting lids and are in good repair. Food is provided daily by the District. Food is stored per regulation. Staff preparing food are using proper personal hygiene and food service practices. The food meets the nutritional requirements per regulation and is of good quality and proper quantity. The breakfast/lunch menu is posted, changes are recorded, and menus are stored for 30 days. Food has been stored separately from any chemicals or cleaning products. Drinking water is readily available. There is no napping in the program. Hand washing and toileting areas are in a safe, sanitary and operating condition. Any waste water used to clean is being discarded after use. Medications are kept in the school nurse's office, inaccessible to children. LPA suggested keeping the EpiPens in the classroom for quicker access. Poisons, disinfectants, cleaning solutions and other items that are dangerous to children have been made inaccessible. There is no evidence of rodent or insect activity. Outdoor play area is fully fenced with sufficient cushioning and adequate shade.. Age appropriate playground equipment and outdoor surfaces are in a safe condition with any equipment securely bolted to the ground. Portable water is used outdoors. There are no bodies of water, firearms or ammunition on the property. The carbon monoxide detector is operational. The facility has a written disaster plan in place that meets regulatory requirement and has been conducting and documenting evacuation drills every month with the school. The last drill was conducted on 6/6/2023. The facility does not transport children. Ms. Macias stated lead testing was done this year. LPA will confirm with District.

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Joelle Redding
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

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: CAJON VALLEY MADISON ELEMENTARY STATE PRESCHOOL	FACILITY NUMBER: 376105070
	VISIT DATE: 06/07/2023

NARRATIVE

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LPA reviewed sign in/out procedures (sign in w/Learning Genie @ gate), a sample of personnel records and a sample of children's records. All staff present with current CPR and First Aid certification. Mandated Reporter training is taken through the District with a Community Care Licensing approved course.

Children are evaluated upon entry and monitored throughout the day for signs of illness. The isolation area for ill children awaiting pick up is the nurse's office. Reporting requirements for communicable disesases in children or staff were discussed to include contact with County Department of Public Health for guidance (619-692-8499) and Licensing (619-767-2248) to report the unusual incident for three or more cases.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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 . Services are in place today. LPA recommended keeping the EpiPen in the classroom instead of the nurse's office for easier and quicker access by appropriately trained staff.

During this visit, LPA followed up on a self reported incident that occurred on 4/28/23, wherein a child was injured in a fall on the playground. LPA spoke with all staff who were present at the time of the incident and inspected the area around the incident. All items were age appropriate and sufficient cushioning was in place as the incident occurred on the grassy area of the playground. There were approximately 23 children on the playground at the time with two teachers and an assistant. Supervision was in place, staff responded appropriately and timely.

Ms. Macias 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. All staff is fingerprint cleared through the District.

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Joelle Redding
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

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: CAJON VALLEY MADISON ELEMENTARY STATE PRESCHOOL	FACILITY NUMBER: 376105070
	VISIT DATE: 06/07/2023

NARRATIVE

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Licensee is signed up for Quarterly Updates and Provider Information Notices (PINs) for one or more programs on our website: www.ccld.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

LPA conducted child care quality management interview with AM Lead Teacher Teresa Macias. Exit interview conducted and report was reviewed with Ms. Macias.

LPA received an updated LIC 610 and 500 today.

See LIC 809D for Type B deficiency.

NOTICE OF SITE VISIT WAS GIVEN AND WILL REMAIN POSTED FOR 30 DAYS. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Joelle Redding
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/07/2023 03:01 PM - It Cannot Be Edited

Created By: Joelle Redding On 06/07/2023 at 02:39 PM

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: CAJON VALLEY MADISON ELEMENTARY STATE PRESCHOOL	FACILITY NUMBER: 376105070
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on file review and interview with Staff #1, the Licensee did not comply with the section cited above in that Staff #1 did not have Measles immunization information on file which poses/posed a potential health, safety or personal rights risk to children in care.
	POC Due Date: 06/21/2023
	Plan of Correction
1 2 3 4	Ms. Macias states that she will provide the report to the District for correction.

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:

Renesha Askew

LICENSING EVALUATOR NAME:

Joelle Redding

LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

LIC809 (FAS) - (06/04)

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