376701351-2-6-2023-20-CC-VWIN-CNSVDP-20230206152104

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376701351
Report Date: 02/06/2023
Date Signed: 02/06/2023 03:21:12 PM

Document Has Been Signed on 02/06/2023 03:21 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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	UCP SAN DIEGO DBA- S D COOPERATIVE PRESCHOOL		FACILITY NUMBER:	376701351
ADMINISTRATOR:	STEPHANIE LARSON		FACILITY TYPE:	830
ADDRESS:	4190 FRONT STREET		TELEPHONE:	(619) 295-9860
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92103
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 6	CENSUS: 4	DATE:	02/06/2023
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Stephanie Larson		TIME COMPLETED:	03:30 PM

NARRATIVE

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On 2/6/23, at 1:30 pm, Licensing Program Analyst (LPA), Vicky Williamson arrived at the faciity to conduct a case management inspection for the purpose of an annual continuation inspection. LPA met with Director Stephanie Larson and toured Room 111. There were four (4) napping infants with one (1) teacher present during today’s inspection.

The purpose of today's annual continuation inspection is to review and discuss the staff files that were reviewed during the annual required inspection on 2/2/23. The staff files reviewed were for all staff members that were present during the annual required inspection that was conducted on 2/2/23. LPA reviewed a sample of staff files and observed files were incomplete for Staff 1 (S1). There was no health screening report or immunization records on file for S1 during the time of inspection; see deficiencies cited on LIC 809D. Staff files reviewed had documentation of completed mandated reporter training. On 2/2/23, LPA and Director discussed the incomplete staff files however due to a computer malfunction the facility report was unable to be completed. Director stated that she understood that all staff files must be completed prior to the start of employment at the facility.

The name of the child care center director or fully - qualified teacher designated to act in the director’s absence has been reported to the Department. The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. Children are under supervision, including visual supervision, of a teacher at all times. Facility maintains a ratio of one teacher supervising no more than four (4) children in care. LPA reviewed a sample of children’s files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child and medical assessment

See LIC809C continuation...

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023

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 02/06/2023 03:21 PM - It Cannot Be Edited

Created By: Vicky Williamson On 02/06/2023 at 02:06 PM

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: UCP SAN DIEGO DBA- S D COOPERATIVE PRESCHOOL	FACILITY NUMBER: 376701351
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in 1 out of 3 staff members, as Staff 1 did not have immunization records available for review which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/13/2023
	Plan of Correction
1 2 3 4	Director stated that she will submit a copy of immunization records for Staff 1 to LPA Williamson, no later than 2/13/23

Type B

Section Cited

CCR

101216(g)(2)

Personnel Requirements

(2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in 1 out of 3 staff members, as Staff 1 did not have a health screening report available for review during time of inspection which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/13/2023
	Plan of Correction
1 2 3 4	Director stated that she will provide a copy of health screening report for Staff 1 to LPA Williamson, no later than 2/13/23.

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:

Tulam Vu

LICENSING EVALUATOR NAME:

Vicky Williamson

LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023

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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: UCP SAN DIEGO DBA- S D COOPERATIVE PRESCHOOL	FACILITY NUMBER: 376701351
	VISIT DATE: 02/06/2023

NARRATIVE

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This facility provides Incidental Medical Services (IMS). LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA discussed safe sleep regulations with director 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 director 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.

LPA and director discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, mandated reporter training, safe sleep in child care, California Megan’s Law (www.meganslaw.ca.gov).

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiency is being cited: See LIC 809D.

Exit interview conducted with Director Stephanie Larson, and a copy of this report, Appeal Rights and Notice of Site Visit were provided. Notice of Site Visit is required to be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

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.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023

LIC809 (FAS) - (06/04)

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