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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701283
Report Date: 05/31/2022
Date Signed: 05/31/2022 11:32:05 AM

Document Has Been Signed on 05/31/2022 11:32 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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:RESURRECTION PRESCHOOLFACILITY NUMBER:
376701283
ADMINISTRATOR:NELDA JOUSTRAFACILITY TYPE:
850
ADDRESS:12730 ELM PARK LANETELEPHONE:
(858) 442-2206
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 17DATE:
05/31/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Nelda JoustraTIME COMPLETED:
11:45 AM
NARRATIVE
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On May 31, 2022 at 10:35 a.m. Licensing Program Analyst, Leilani Curtis, conducted an unannounced case management inspection regarding the facility carbon monoxide detector. Upon arrival LPA met with Director Nelda Joustra and proceeded to tour the facility. There were 17 children with 2 staff members present. Appropriate ratio/capacity were observed. Staff members have the required background clearances and are associated to the facility. LPA reviewed the facility sign in/sign out sheets and noticed that 3 of the 17 children present had not been signed in by their parent/authorized representative.

On 5/23/22 LPA Curtis conducted an annual inspection at the facility. At the time of inspection LPA was unable to test the carbon monoxide detector. The director stated that the carbon monoxide detector was part of the fire/smoke detector system which is “hard wired” into the building. The director stated that the alarm company had visited the facility in April 2022 and the system passed. On 5/25/22 the director sent LPA a copy of the Fire Alarm and Emergency Communication System Inspection and Testing Form from Bay Alarm Company dated 4/21/22 which states that the fire alarm system passed but that the facility does not have a combination system which contains carbon monoxide detection. LPA also contacted the technician who tested the system on 4/21/22 who confirms that carbon monoxide detection is not part of the system. The facility did not have an operating carbon monoxide detector at the time of the annual inspection on 5/23/22. On 5/24/22 the director sent LPA an email of a newly purchased carbon monoxide detector. During today’s inspection LPA observed that the new detector is operating.

See LIC809 for cited deficiencies.

An exit interview was conducted with the director and appeal rights (LIC 9058 1/16) were discussed. The director’s signature on this form acknowledges receipt of these rights. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA observed the director post notice of site visit.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2022
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 05/31/2022 11:32 AM - It Cannot Be Edited


Created By: Grace Curtis On 05/31/2022 at 10:54 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: RESURRECTION PRESCHOOL
FACILITY NUMBER: 376701283

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/31/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/31/2022
Section Cited
HSC
1596.954

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1596.954: Carbon monoxide detectors required; inspection : Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections. This requirement was not met as evidenced by:
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The director purchased and installed an operational carbon monoxide detector on 5/24/22. LPA observed the carbon monoxide detector operating during today’s (5/31/22) visit.
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Based on LPA's observation during the facility’s 5/23/22 annual inspection and fire alarm inspection report dated 4/21/22. the facility did not maintain an operating carbon monoxide detector. This poses a potential health and safety risk to children in care.
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Type B
06/08/2022
Section Cited
CCR101229.1(b)

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101229.1(b) Sign In and Sign Out:
(b) The person who brings the child to, and removes the child from, the center shall sign the child in/out. This requirement was not met as evidenced by:
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The director states that she will write a letter to the parents stating that they must sign their children in and out. The director will send LPA a copy of the letter along with signed parent acknowledgements of the letter via email or mail by POC due date of 6/8/22.
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Based on record review, three of the 17 children present were not signed in by their parent/authorized representative. The poses a potential health and safety risk to 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:Tashima Daniel
LICENSING EVALUATOR NAME:Grace Curtis
LICENSING EVALUATOR SIGNATURE:
DATE: 05/31/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/31/2022


LIC809 (FAS) - (06/04)
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