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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105098
Report Date: 01/24/2024
Date Signed: 01/24/2024 05:34:55 PM

Document Has Been Signed on 01/24/2024 05:34 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:TIERRASANTA ELEMENTARYFACILITY NUMBER:
376105098
ADMINISTRATOR:ROBIN BRUSTFACILITY TYPE:
840
ADDRESS:5450 LA CUENTA DRIVETELEPHONE:
(858) 496-8255
CITY:SAN DIEGOSTATE: CAZIP CODE:
92124
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 40DATE:
01/24/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
03:11 PM
MET WITH:Robin BrustTIME COMPLETED:
05:40 PM
NARRATIVE
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On 1/24/24 at 3:11 PM Licensing Program Analyst (LPA) Keturah Lane conducted an unannounced required 3-year inspection at the facility. Upon arrival, LPA met with facility representative Director Robin Brust. This school-age program is located on Tierrasanta Elementary (Unified San Diego School District) campus. LPA observed 40 daycare children present with 6 staff members including Director in the auditorium during the inspection.

During this visit, LPA inspected the auditorium, activity room and bathroom. Fire clearance was granted 8/22/22 for capacity of 60 children. First Aid Kit/Medication is located in activity room in locked cabinet. Both are kept inaccessible from children. Facility sign-in and outs will be located in auditorium. Last fire drill was conducted in October 2023, however, was not documented on the drill log (see LIC9102 TV). Children’s records were reviewed and the records reviewed were found to be complete. Staff records were reviewed, and LPA observed one staff member did not have proof of immunization to measles or pertussis in the staff files. Director stated she would obtain the proof of immunizations and e-mail it to LPA Lane by 2/7/24.

Per H&S Code 1596.806, facility is exempt from square footage, toilet, isolation space, outdoor activity space and fencing requirements. All indoor and outdoor activity spaces utilized for the school age children were inspected. Rooms auditorium and activity room next to auditorium were observed to have age-appropriate furniture and equipment, including tables, chairs, bookshelves and other activity supplies for the children. LPA observed separate bathrooms with privacy. There is a separate bathroom utilized for ill children in the Kindergarten area. (continued on LIC809-C...)

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2024
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 Has Been Signed on 01/24/2024 05:34 PM - It Cannot Be Edited


Created By: Keturah Lane On 01/24/2024 at 04:36 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: TIERRASANTA ELEMENTARY

FACILITY NUMBER: 376105098

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 01/24/2024

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
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Based on record review, the licensee did not comply with the section cited above in 1 out of 6 staff files which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/07/2024
Plan of Correction
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Director stated she would obtain immunizations (Measles & Pertussis) for staff member Axel Juarez and e-mail to LPA Lane at: Keturah.Lane@dss.ca.gov by 2/7/24.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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 Daniel
LICENSING EVALUATOR NAME:Keturah Lane
LICENSING EVALUATOR SIGNATURE:
DATE: 01/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/24/2024


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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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: TIERRASANTA ELEMENTARY
FACILITY NUMBER: 376105098
VISIT DATE: 01/24/2024
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There is an operational carbon monoxide detector located in activity room next to auditorium. Snack menu is posted, as well as all other required documents. LPA observed snacks/food preparation area and observed to be free of rodents and/or vermin. Snacks are located in cabinet in activity room and refrigerator location is in the staff lounge area. All foods/beverages capable of rapid spoiling are stored in covered containers at 45 F or less.

The outdoor playground area was inspected. Area has trees & canopies for shade. LPA observed play structure to be age appropriate for children ages 5 years and up. Children under 5 years are not allowed on the structure. LPA observed appropriate cushioning under structure. Drinking water is readily accessible inside and outside the classroom via water bottles and water bottle refill station. Facility representative is reminded that any changes to the facility must be reported to and approved by Community Care Licensing.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. (continued on LIC809-C...)

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024
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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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: TIERRASANTA ELEMENTARY
FACILITY NUMBER: 376105098
VISIT DATE: 01/24/2024
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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 PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

Please see LIC809-D for Type B deficiency cited.

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.

Exit interview conducted and report was reviewed with facility representative Director Robin Brust. A notice of site visit was provided and must remain posted for 30 days.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024
LIC809 (FAS) - (06/04)
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