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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701083
Report Date: 07/31/2024
Date Signed: 07/31/2024 12:36:18 PM

Document Has Been Signed on 07/31/2024 12:36 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:KARL H. KELLOGG ELEMENTARY SCHOOLFACILITY NUMBER:
376701083
ADMINISTRATOR/
DIRECTOR:		BRANDI SHEPPYFACILITY TYPE:
850
ADDRESS:229 EAST NAPLES STREETTELEPHONE:
(619) 420-4151
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 17DATE:
07/31/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:10 AM
MET WITH:Veronica Moreno, Lead TeacherTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
NARRATIVE
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Licensing Program Analysts (LPAs) D. Sanchez and D. Huerta, made an unannounced follow up Case Management inspection to the facility today in response to an Unusual Incident/Injury Report received in the San Diego Child Care Regional Office (SDCCRO) on 07/29/2024. Incident report states that on 7/26/2024, child eloped from facility premises outside the school security gate.

LPAs interviewed facility staff and reviewed Child #1 (C1) document during today's inspection.
Facility staff admitted child walked out of the preschool playground gate while they were out in the playground area. C1 was found by the elementary school teacher who observed C1 walking down the ramp that leads to the school parking lot. Although C1 was under the elementary school staff supervision, facility staff was not aware of C1 missing from preschool premises. Shortly after lead teacher discovered C1 sitting in the principal's office. (see LIC-809D)

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiency is being cited: (see next page, LIC-809D)

An exit interview was conducted with Site Supervisor. Supervisor was provided a copy of their appeal rights (LIC 9058)

Upon receipt of a Type A violation, 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 - Child Care Parent Notification Requirements and a copy of LIC 9224 was given to licensee.

LPA observed provider placing the Notice of Cite Visit on the wall visible to parents during today’s inspection.

NOTICE OF SITE VISIT MUST BE POSTED FOR 30 DAYS
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Diana Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/31/2024
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 07/31/2024 12:36 PM - It Cannot Be Edited


Created By: Diana Sanchez On 07/31/2024 at 11:53 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: KARL H. KELLOGG ELEMENTARY SCHOOL
FACILITY NUMBER: 376701083

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/31/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/01/2024
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision - No children shall be left without the supervision of a teacher at any time... Supervision shall include visual observation.
This requirement was not met as evidenced by:
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Lead Teacher stated that she will ensure to have the Morning Lead Teacher send a written statement to the San Diego Child Care Regional Office (SDCCRO) advising a plan to prevent this incident from occurring again.
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Based on interviews conducted and staff admission facility staff did not comply with the above regulation, as C1 eloped from preschool premises, which poses an immediate 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:Jason Garay
LICENSING EVALUATOR NAME:Diana Sanchez
LICENSING EVALUATOR SIGNATURE:
DATE: 07/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/31/2024


LIC809 (FAS) - (06/04)
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