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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700372
Report Date: 02/11/2025
Date Signed: 02/11/2025 11:15:43 AM

Document Has Been Signed on 02/11/2025 11:15 AM - 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:LMSVSD - BANCROFT PRESCHOOLFACILITY NUMBER:
376700372
ADMINISTRATOR/
DIRECTOR:		KIMBERLY LIBENGUTHFACILITY TYPE:
850
ADDRESS:8805 TYLER STREETTELEPHONE:
(619) 668-5890
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY: 24TOTAL ENROLLED CHILDREN: 20CENSUS: 15DATE:
02/11/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Terri PottsTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On 2/11/2025, at 9:00 am, Licensing Program Analysts (LPAs) Vicky Williamson and Rania Alexanian conducted an unannounced annual random inspection and met with Lead Teacher, Teri Potts. LPAs disclosed the purpose of the inspection and toured the indoor and outdoor of the facility. This is a half day program which operates under a traditional school year schedule following the La Mesa/Spring Valley School District (LMSVSD). The preschool is located at Bancroft Elementary. Days and hours of operation are Monday through Friday from 8:30 a.m. to 11:30 a.m. There is currently one classroom in operation. The following ratios were observed:

Class Room 2B – 15 children with one (1) teacher and two (2) paraprofessionals.

Furniture and equipment are in good condition. Floors in the facility are clean and safe. Disinfectants, cleaning solutions, medications and other hazardous items were made inaccessible to children during time of inspection. Solid waste storage containers have tight fitting covers and are in good repair. The surface of the outdoor activity space is maintained in a safe condition and free of hazards. Playground equipment is in safe condition. LPAs observed an additional play structure on the playground that is use for children enrolled in the preschool program that is for children ages 5 years to 12 years. Lead Teacher was advised to assure that the preschool children do not utilize the play structure due to it is not age appropriate. The additional structure of the outdoor area is appropriate for children ages 2 through 5 years old. There is sufficient cushioning under the play structure by the use of rubber matting. Shade in the outdoor area is provided by canopies. Facility has smoke and carbon monoxide detectors that meets statutory requirements. The last fire/disaster was conducted and documented on 1/16/2025.

Lead Teacher stated that there are no swimming pools or other bodies of water on the premises. Lead Teacher stated that there are no firearms or ammunition allowed or stored on the premises.
See LIC 809C Continuation...
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE: DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/11/2025
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: LMSVSD - BANCROFT PRESCHOOL
FACILITY NUMBER: 376700372
VISIT DATE: 02/11/2025
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The restrooms is located inside of the classroom. All toilets and hand washing areas were observed to be in safe and sanitary operating condition.

The elementary school cafeteria provides breakfast to the children. Menus are posted weekly. Drinking water is available both indoors and outdoors. Children bring their own water bottles.

Lead Teacher 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. Lead Teacher, Teri Potts stated that all employee’s working for the preschool have received criminal record clearances and health screenings through the La Mesa/Spring Valley School District (LMSVSD).

Capacity and limitations as specified on the license are being maintained. Children are under supervision, including visual supervision, of a teacher at all times. Facility maintains a ratio of one teacher supervising no more than eight (8) children in care.

At least one person trained in CPR and Pediatric First Aid is present when children are at the facility. The name of the facility representative and the fully qualified teacher designated to act in the facility representative’s absence has been reported to the Department. LPA reviewed facility sign in /sign out sheets. Lead Teacher was reminded that the person who signs the child in and out of the facility shall use their full legal signature and record the time of day.

LPA reviewed a sample of children’s files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child and medical assessment. LPA reviewed a sample of staff files and observed files were complete with immunization records for influenza, pertussis and measles and current documentation of completed mandated reporter training.

See LIC 809C Continuation...

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025
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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: LMSVSD - BANCROFT PRESCHOOL
FACILITY NUMBER: 376700372
VISIT DATE: 02/11/2025
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This facility provides Incidental Medical Services – IMS, however there are no children requiring IMS at this time. 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-care-centers/.


Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed - related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

LPA discussed and provided lead teacher with the following: childcare advocates email address: childcareadvocatesprogram@dss.ca.gov. In addition, for general questions or questions regarding licensing requirements contact the Child Care Licensing Duty Line at (619) 767-2248.


Please visit the Guardian web page and set-up your Guardian account. https://cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian If you have any questions regarding Guardian, please contact CDSS at email: guardian@dss.ca.gov

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.
See LIC 809C Continuation...
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: LMSVSD - BANCROFT PRESCHOOL
FACILITY NUMBER: 376700372
VISIT DATE: 02/11/2025
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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

One (1) Technical Assistance was issued for 101239(m) Fixtures, Furniture, Equipment and Supplies.

No deficiencies cited. A Notice of Site Visit (LIC 9213) was given to Lead Teacher, Teri Potts and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Appeal Rights (LIC 9058) was provided. Exit interview conducted and report was reviewed with Lead Teacher, Teri Potts.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025
LIC809 (FAS) - (06/04)
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