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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700830
Report Date: 08/03/2022
Date Signed: 08/03/2022 02:45:47 PM


Document Has Been Signed on 08/03/2022 02:45 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:RJ'S ACADEMYFACILITY NUMBER:
376700830
ADMINISTRATOR:JENNIFER MARQUEZFACILITY TYPE:
850
ADDRESS:6845 UNIVERSITY AVENUETELEPHONE:
(619) 269-1580
CITY:SAN DIEGOSTATE: CAZIP CODE:
92115
CAPACITY:96CENSUS: 34DATE:
08/03/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Angel SaldivarTIME COMPLETED:
03:00 PM
NARRATIVE
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On 08/03/2022 at 1:00pm, Licensing Program Analyst (LPA) Samantha Clenista conducted an unannounced case management site inspection to follow up on a self-reported incident that occurred on 04/06/2022. Upon LPA’s arrival, LPA met with newly assigned Director, Angel Saldivar, and proceeded to tour the facility. LPA obtained director's packet from Ms. Saldivar. There was a total of 34 children with a total of 6 staff members. Children were observed napping. Appropriate ratio, capacity and supervision was observed.

The incident that the facility reported to Child Care Licensing on 04/08/2022, involved Child #1 being placed to nap in an area mainly used for storage and diaper changing. LPA conducted the initial follow up of this incident on 04/26/2022, where LPA observed where the incident occurred, interviewed several staff members, and obtained video footage and related confidential documentation of the incident.

Based upon information gathered through interviews, observations and supporting documents, it has been confirmed that there were two violations that occurred during the 04/06/2022 incident. Child #1 personal rights were violated as she was rough handled by a Staff #1. Staff #1 dragged Child #1 on a cot while she was still on it. Staff #1 also kicked the cot that the child was on. Child #1 was placed to nap in an area that is mainly used for storage and diaper changing. The room that the child was placed in had cots, storage boxes, toys, and hazardous items (Lysol spray and wipes) stacked up on each other, surrounding Child #1.

See 809-C for continuation...
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha ClenistaTELEPHONE: (619) 818-6740
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2022
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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: RJ'S ACADEMY
FACILITY NUMBER: 376700830
VISIT DATE: 08/03/2022
NARRATIVE
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See 809D for cited deficiencies. Exit interview was conducted with Ms. Saldivar. LPA provided a copy of LIC 9213, “Notice of Site Visit,” and observed Ms. Saldivar post it at conclusion of visit. LIC9213 shall remain posted for 30 consecutive days.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. A copy of the Fact Sheet - AB 633 Child Care Parent Notification Requirements and a copy of LIC 9224 was reviewed and provided to Ms. Saldiva at conclusion of visit. Ms. Saldivar stated her understanding.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha ClenistaTELEPHONE: (619) 818-6740
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 08/03/2022 02:45 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: RJ'S ACADEMY
FACILITY NUMBER: 376700830

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/04/2022
Section Cited

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Personal Rights. To be accorded dignity in his/her personal relationships with staff and other persons. This requirement was not met as evidenced by;
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Child #1 personal rights were violated as she was rough handled by a Staff #1. Staff #1 dragged Child #1 on a cot while she was still on it. Staff #1 also kicked the cot that the child was on while the child was on it. This poses an Immediate Health and Safety risk to the clients in care.
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reviewed it and understand it no later than 08/04/2022. LPA also provided Ms. Saldiva a link of where to watch a video regarding Personal Rights and to share it with her staff. Ms. Saldiva stated that she will host a staff meeting and provide LPA proof of each staff member's written acknowledgement of the regulation and video no later than 08/29/2022.

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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: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha ClenistaTELEPHONE: (619) 818-6740
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4


Document Has Been Signed on 08/03/2022 02:45 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: RJ'S ACADEMY
FACILITY NUMBER: 376700830

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/05/2022
Section Cited

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Building and Grounds. The childcare center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement was not met as evidenced by;
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Child #1 was placed to nap in an area that is not part of the normal children's area. This area she was placed in had cots, storage boxes, toys, and hazardous items (Lysol spray and wipes) stacked up on each other where it could have fallen on the child. This poses a Potential Health and Safety risk to the clients in care.
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to her staff via email to review and have them acknowledge that they reviewed it and understand it. Ms. Saldiva stated that she will provide LPA proof of each staff member's written acknowledgement of the regulation.

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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: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha ClenistaTELEPHONE: (619) 818-6740
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4