376701345-12-12-2022-51-CC-ALMA-CM32UT-20221212164251

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376701345
Report Date: 12/12/2022
Date Signed: 12/12/2022 04:43:08 PM

Document Has Been Signed on 12/12/2022 04:43 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:	COASTAL CHRISTIAN ACADEMY		FACILITY NUMBER:	376701345
ADMINISTRATOR:	KAREN CAMPBELL		FACILITY TYPE:	850
ADDRESS:	4633 DOLIVA DRIVE		TELEPHONE:	(858) 598-6846
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92117
CAPACITY:	37	CENSUS: 23	DATE:	12/12/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Karen Campbell		TIME COMPLETED:	05:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 12/12/22 at 11:45 AM, Licensing Program Analyst (LPA) Adrian Mangina visited the facility to conduct an annual inspection. Upon arrival LPA met with Director Karen Campbell and proceeded to tour the facility. During today's inspection, there were 23 children with 4 staff in 3 classrooms. Appropriate ratios and capacity were observed. Appropriate care & visual supervision were also observed during the inspection while children were seated having lunch. Furniture and age appropriate equipment is in good condition. Rooms have adequate heating, lighting, ventilation. Floors appear to be clean and safe. Drinking water is readily accessible. Facility uses filtered water in classrooms. Bathrooms are maintained with operational toilets and faucets with appropriate temperature. Paper towels and toilet paper are available. Bathroom is lighted and has ventilation. There is no food service area. Children bring their own lunch and the facility provides snacks which are prepared in the classrooms. Adequate food is available for snacks. Snack menu is posted. Cleaning supplies are kept separate from food and are inaccessible to children. Storage containers for solid waste have tight-fitting covers and are kept in good repair. Director states there are no poisons on premises. Director stated there are no firearms or other weapons on the premises. All foods/beverages capable of rapid spoiling are stored in covered containers at 45 F or less. The facility appears to be free of insects and rodents. There is an operational carbon monoxide detector at the facility. Last fire drill was conducted on 9/23/22 and last earthquake drill was conducted on 10/20/22. The fire department last inspected the facility on 8/2/22. All required documents were posted. Outdoor play area is a fenced playground with sufficient material for cushioning. Facility has a waiver to stagger the classes playing outside with no more than 2 classes outside at one time. There are no bodies of water or weapons at this facility. Climbing structures, swings and slides are securely fixed to the ground. Area has trees and large umbrellas used for shade. Equipment is age appropriate. Area has drinking water readily accessible and grounds are free of debris or potential hazards. (continued on LIC809-C...)

SUPERVISOR'S NAME: Renesha Askew	TELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Adrian L Mangina	TELEPHONE: (619) 629-6197
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022

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 12/12/2022 04:43 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: COASTAL CHRISTIAN ACADEMY	FACILITY NUMBER: 376701345
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/12/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101226(e)(1)(B)

Health-Related Services

(e) In centers where the licensee chooses to handle medications: (1) All prescription and nonprescription medications shall be centrally stored in accordance with the requirements specified below: (B) Each container shall have an unaltered label. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based observation the licensee did not comply with the section cited above as inhaler did not have original packaging for child 1, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/09/2023
	Plan of Correction
1 2 3 4	Licensee states will obtain original packaging for prescritption and provide proof to LPA no late rthan close of business 1/9/22.

Type B

Section Cited

CCR

101226(e)(3)(A)

Health-Related Services

(3) Prescription medications may be administered if all of the following conditions are met: (A) Prescription medications shall be administered in accordance with the label directions as prescribed by the child's physician. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation the licensee did not comply with the section cited above as the inhaler for child 1 does not have a prescription, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/09/2023
	Plan of Correction
1 2 3 4	LIcensee states will ensure medication for child 1 has label and provide proof to LPA no late rthan close of business 1/9/22.

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: Renesha Askew	TELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Adrian L Mangina	TELEPHONE: (619) 629-6197
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/12/2022 04:43 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: COASTAL CHRISTIAN ACADEMY	FACILITY NUMBER: 376701345
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/12/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101226(e)(5)

Health-Related Services

(5) The licensee shall develop and implement a written plan to record the administration of prescription and nonprescription medications and to inform the child's authorized representative daily when such medications have been given. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation the licensee did not comply with the section cited above as Facility does not have and IMS plan and is administrering medications to children in care, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/09/2023
	Plan of Correction
1 2 3 4	Facility Representative states will develop an IMS plan no later that close of busienss 1/9/22.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Renesha Askew	TELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Adrian L Mangina	TELEPHONE: (619) 629-6197
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022

LIC809 (FAS) - (06/04)

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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: COASTAL CHRISTIAN ACADEMY	FACILITY NUMBER: 376701345
	VISIT DATE: 12/12/2022

NARRATIVE

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LPA reviewed medication storage. LPAs observed 1 children’s medication that did not have the original box or label on inhaler. At least one staff member has current CPR and First Aid certifications. Three staff have not their renewed mandated reporter training. All staff have required immunizations. Each personnel record contains documentation of educational background and training. Sign ins were reviewed. Children’s records contain admission agreements and medical assessment. A review of staff records on this date indicates that all staff members are associated to the facility. All facility staff who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Facility representative 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. A civil penalty of $100 was assessed for the staff member not associated today.

LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative 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.

(continued on LIC809--C...)

This facility provides Incidental Medical Services – IMS. Facility does not have an Incidental Medical Services Plan. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

continued on LIC809 page 3

SUPERVISOR'S NAME: Renesha Askew	TELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Adrian L Mangina	TELEPHONE: (619) 629-6197
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022

LIC809 (FAS) - (06/04)

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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: COASTAL CHRISTIAN ACADEMY	FACILITY NUMBER: 376701345
	VISIT DATE: 12/12/2022

NARRATIVE

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LIC809 page 3

Pursuant to Title 22 of the CA Code of Regulations, the following Type B deficiencies were cited (refer to LIC 809-D) and LIC9102 for technical violation given.

Exit interview conducted and report was reviewed with the facility representative, Karen Campbell. A notice of site visit was given and must remain posted for 30 days.

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/inspection-process.

SUPERVISOR'S NAME: Renesha Askew	TELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Adrian L Mangina	TELEPHONE: (619) 629-6197
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022

LIC809 (FAS) - (06/04)

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