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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701039
Report Date: 02/07/2022
Date Signed: 02/07/2022 12:00:18 PM

Document Has Been Signed on 02/07/2022 12:00 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:GOOD SHEPHERD CATHOLIC SCHOOLFACILITY NUMBER:
376701039
ADMINISTRATOR:DESIREE FAJOTAFACILITY TYPE:
850
ADDRESS:8180 GOLD COAST DRIVETELEPHONE:
(858) 693-1522
CITY:SAN DIEGOSTATE: CAZIP CODE:
92126
CAPACITY: 60TOTAL ENROLLED CHILDREN: 65CENSUS: 37DATE:
02/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Desiree FajotaTIME COMPLETED:
12:15 PM
NARRATIVE
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On 2/7/2022 @ 8:55AM, LPA Nancy Diaz conducted an unannounced inspection. LPA met with Desiree Fajota, Director. Observed present today were 37 preschool children. A tour of the facility was conducted. There are two classrooms designated for preschool children use. Program operates 7:00AM to 3:30PM.
A review of staff records on this date indicates that one facility staff who has an existing fingerprint clearance on the database is not associated to the facility. The licensee has not exceeded the conditions, limitations and capacity specified on the license. At least one person is trained in CPR and Pediatric First aid was present today - Director and two teachers.

Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are inaccessible. Medications are kept in a safe place, inaccessible to children. Furniture and equipment are in good condition, free of sharp, loose or pointed parts. All toilets, handwashing facilities are in safe and sanitary operating condition. All floors are clean and safe. The child care center was observed to be clean, safe, sanitary and in good repair to ensure the safety and well-being of children, employees and visitors. Facility maintains a carbon monoxide detector that meet the standards established in Chapter 8 of Part 2 of Division 12.

All storage containers for solid waste have a tight-fitting covers that are kept on and in good repair.

Playground equipment was observed to be in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space are maintained in safe condition and free of hazards. The areas around or under high climbing equipment, swings, slides, and similar equipment was cushioned with material that absorbs a fall.

An isolation area has been designated for children who becomes ill during the day.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2022
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 02/07/2022 12:00 PM - It Cannot Be Edited


Created By: Nancy Diaz On 02/07/2022 at 11:17 AM
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: GOOD SHEPHERD CATHOLIC SCHOOL
FACILITY NUMBER: 376701039

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101170(e)(2)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 101170(f) or

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. Staff Vivian Guico's fingerprint is not associated to the facility. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/07/2022
Plan of Correction
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Staff Vivian Guico's fingerprint is in Guardian's database, however facility failed to submit a request to transfer her clearance. Ms. Guico was hired in August 2021.
Ms. Fajota will submit form LIC 9182 with a copy of signed LIC 508 and photo ID today, 2/7/2022.
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:Nancy Diaz
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2022


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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: GOOD SHEPHERD CATHOLIC SCHOOL
FACILITY NUMBER: 376701039
VISIT DATE: 02/07/2022
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Children’s records were reviewed today. All required forms were on file. All children are signed in/out by a representative who uses a full legal signature and has recorded the time of day. Child’s record also contain a medical assessment.

Staff records reviewed today contain a health screening as required by the regulation.
The majority of staff have completed the mandated reporter training (effective 3/2018). This training shall be renewed every two years. All staff have immunization record indicating that they have been immunized against influenza, pertussis and measles.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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

Ms. Fajota 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.

LPA also informed Ms. Fajota of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2022
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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: GOOD SHEPHERD CATHOLIC SCHOOL
FACILITY NUMBER: 376701039
VISIT DATE: 02/07/2022
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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.

A notice of site visit was given and observed posted. This notice shall remain posted for 30 days.

Civil Penalty was assessed.

Exit interview conducted with Ms. Fajota. Licensing report was reviewed with Ms. Fajota. A copy of the report and appeal rights were provided today.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2022
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