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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701057
Report Date: 01/04/2023
Date Signed: 01/04/2023 02:02:24 PM

Document Has Been Signed on 01/04/2023 02:02 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:KIDDIES KORNERFACILITY NUMBER:
376701057
ADMINISTRATOR:SANYA KERNEYFACILITY TYPE:
850
ADDRESS:12334 OAK KNOLL ROADTELEPHONE:
(858) 486-1775
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 12DATE:
01/04/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Sanya KerneyTIME COMPLETED:
01:30 PM
NARRATIVE
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On 1/4/23 LPA Annette Sutherland and LPM Monica Cuddy conducted a case management inspection. The facility was toured and census was taken. Upon arrival there were 12 children and 1 qualified staff in 1 classroom. Cleaning supplies in staff bathroom and kitchen are accessible to children. Vinyl on changing pad is torn and foam is exposed.


See LIC 809D for Type A & B deficiency.

LPA Annette Sutherland and LPM Monica Cuddy informed facility representative Sanya Kerney that this report dated 1/4/23 documents 1 Type A citation(s) which shall be posted for 30 consecutive days as there is an immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA Annette Sutherland informed the facility representative Sanya Kerney to provide a copy of this licensing report dated 1/4/23 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE: DATE: 01/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/04/2023
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 01/04/2023 02:02 PM - It Cannot Be Edited


Created By: Annette Sutherland On 01/04/2023 at 09:55 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: KIDDIES KORNER
FACILITY NUMBER: 376701057

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/05/2023
Section Cited
CCR
101238(g)(1)

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Buildings and Grounds. Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. This requirement was not met as evidenced by
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Director has put safety gates to make kitchen and staff bathroom inaccessible.
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LPA observed cleaning supplies accesible to children in the kitchen and bathroom. This posses an immediate risk for children 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:Monica Cuddy
LICENSING EVALUATOR NAME:Annette Sutherland
LICENSING EVALUATOR SIGNATURE:
DATE: 01/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/04/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/04/2023 02:02 PM - It Cannot Be Edited


Created By: Annette Sutherland On 01/04/2023 at 10:02 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: KIDDIES KORNER
FACILITY NUMBER: 376701057

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/11/2023
Section Cited
CCR
191239

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Fixtures, Furniture, Equipment and Supplies Furniture and equipment shall be maintained in good condition, free of sharp, loose or pointed parts.
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Director has purchased new changing pads and will provide photo to LPA when received.
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This requirement was not met as evidence by LPA observing torn vinyl on changing pad. This posses a potential risk for children 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:Monica Cuddy
LICENSING EVALUATOR NAME:Annette Sutherland
LICENSING EVALUATOR SIGNATURE:
DATE: 01/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/04/2023


LIC809 (FAS) - (06/04)
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