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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600647
Report Date: 09/24/2024
Date Signed: 09/24/2024 12:54:20 PM

Document Has Been Signed on 09/24/2024 12:54 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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:CAMPO KUMEYAAY HEAD STARTFACILITY NUMBER:
376600647
ADMINISTRATOR/
DIRECTOR:		CRYSTAL KREMENSKYFACILITY TYPE:
850
ADDRESS:39639 OLD HIGHWAY 80TELEPHONE:
(619) 473-9022
CITY:BOULEVARDSTATE: CAZIP CODE:
91905
CAPACITY: 40TOTAL ENROLLED CHILDREN: 31CENSUS: 24DATE:
09/24/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:21 PM
MET WITH:Lari HaneyTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
NARRATIVE
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On 9/24/2024 at 12:21pm, Licensing Program Analysts (LPAs) Vicky Williamson and Angela Nguyen conducted an unannounced case management inspection for the purpose of citing for deficiencies observed during another inspection at the facility. LPAs met with Site Supervisor, Lari Haney and disclosed the purpose of the inspection. There were 24 children present with six (6) staff members.

A review of staff files were incomplete for AB 1207 mandated reporter training certification for Staff 1 (S1) which expired on 9/14/2024 and Staff 2 (S2) expired on 8/16/2024.

Per California Code of Regulations, Title 22, Division 12, Chapter 1, deficiencies are being cited on the attached LIC 809D.

Exit interview was conducted and report was reviewed with Site Supervisor, Lari Haney. Appeal Rights and Notice of Site Visit were given. Notice of Site Visit is required to be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. LPA observed Notice of Site Visit posted on the bulletin board in the lobby.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE: DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 09/24/2024 12:54 PM - It Cannot Be Edited


Created By: Vicky Williamson On 09/24/2024 at 12:30 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: CAMPO KUMEYAAY HEAD START
FACILITY NUMBER: 376600647

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/11/2024
Section Cited
HSC
1596.8662(b)(1)

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(b) (1) On or before March 30, 2018, a person who, on January 1, 2018, is a ... employee of a licensed child day care facility shall complete the mandated reporter training... every two years...
This requirement is not met as evidenced by:
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Site Supevisor stated that she will ensure that the mandated reporter training is completed and proof of training submitted to the SDRO, no later than 10/11/2024.
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Based on interview and record review, the licensee did not comply with the section cited above in that mandated reporter certification for S1 expired on 9/14/24 and S2 expired on 8/16/24, 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:Tulam Vu
LICENSING EVALUATOR NAME:Vicky Williamson
LICENSING EVALUATOR SIGNATURE:
DATE: 09/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/24/2024


LIC809 (FAS) - (06/04)
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