376701387-11-7-2023-20-CC-CMER-CXCT6P-20231107132724

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376701387
Report Date: 11/07/2023
Date Signed: 11/07/2023 01:27:38 PM

Document Has Been Signed on 11/07/2023 01:27 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:	CHILDRENS CREATIVE AND PERFORMING ARTS ACADEMY		FACILITY NUMBER:	376701387
ADMINISTRATOR:	IVETTE MARTINEZ		FACILITY TYPE:	850
ADDRESS:	3076 HOWARD AVENUE		TELEPHONE:	(619) 584-2454
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92104
CAPACITY: 28	TOTAL ENROLLED CHILDREN: 28	CENSUS: 5	DATE:	11/07/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Ivette Martinez		TIME COMPLETED:	12:45 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 11/07/2023 at 10:50 a.m. Licensing Program Analyst, Cindy Meier conducted an unannounced annual inspection and met with Licensee, Ivette Martinez. LPA disclosed the purpose of the inspection and toured the inside and outside of the facility. This is a full day program that operates year-round. Days and hours of operation are Monday – Friday, 7:30 a.m. – 5:30 p.m. There is one classroom in operation. The following ratios were observed: five (5) children and one (1) staff member. Furniture and equipment in the classrooms were observed to be in good condition, free of sharp, loose, or pointed parts. The surface of the outdoor activity space and playground equipment is maintained, is in safe condition and is free of hazards. There is sufficient cushioning to absorb falls under and around high play equipment. The playground area includes a shaded rest area for children through the use of canopies and trees. Toilet and hand washing equipment are in safe and sanitary operating condition. Floors in the facility are clean and safe. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors. Napping equipment consists of mats which are kept in the classrooms and each cot has its own sheet or covering. Facility has a functioning carbon monoxide detector that meets statutory requirements. The last fire/disaster drill was conducted and documented on 10/13/23. The facility provides snacks and parents bring the children’s lunch. Menus are posted monthly. Food areas are clean and safe. Notation of children’s allergies is accessible. All food is protected against contamination and any contaminated food is discarded immediately.

SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Cindy Meier
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023

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 11/07/2023 01:27 PM - It Cannot Be Edited

Created By: Cindy Meier On 11/07/2023 at 12:07 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: CHILDRENS CREATIVE AND PERFORMING ARTS ACADEMY	FACILITY NUMBER: 376701387
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101220(a)

Child's Medical Assessments

(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above in that two (2) out of five (5) children did not have a completed LIC701 Health Screening form which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/27/2023
	Plan of Correction
1 2 3 4	Licensee stated she will give the parents form LIC701, have them complete it and return to the facility by 11/27/23. Licensee will submit the completed forms to SDRO by 11/28/23.

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:

Jason Garay

LICENSING EVALUATOR NAME:

Cindy Meier

LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023

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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: CHILDRENS CREATIVE AND PERFORMING ARTS ACADEMY	FACILITY NUMBER: 376701387
	VISIT DATE: 11/07/2023

NARRATIVE

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Director stated there are no bodies of water or on the premises and LPA did not observe any bodies of water. Director stated there are no firearms, weapons, or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, and other hazardous items are made inaccessible to children. No poisons were observed during the inspection.

A review of staff records on this date indicates facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Director 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.

All required notices, forms and license(s) were posted. Capacity and limitations as specified on the license are being maintained. At least one person trained in EMSA approved Pediatric CPR and First Aid is present when children are at the facility or at offsite activities. The name of the childcare center director or fully qualified teacher, designated to act in the director’s absence, has been reported to the Department. Children are under supervision, including visual supervision, of a teacher at all times. The person who signs the child in/out of the facility shall use their full signature and record the time of day. Sign in/out sheets reviewed and observed by the LPA meet this regulation. Facility maintains a ratio of one teacher supervising no more than 12 children in care. This facility does not transport children.

LPA reviewed a sample of children’s files and observed three (3) out of five (5) files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child and medical assessment. LPA reviewed a sample of staff files and observed files were complete with health screening, immunization records for influenza, pertussis, and measles, and current documentation of completed mandated reporter training.

SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Cindy Meier
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023

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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: CHILDRENS CREATIVE AND PERFORMING ARTS ACADEMY	FACILITY NUMBER: 376701387
	VISIT DATE: 11/07/2023

NARRATIVE

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This facility does not provide Incidental Medical Services (IMS). 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 ttps://www.ada.gov/childqanda.htm.
Director stated no children enrolled require medication at this time.

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, Forms and Regulations, Safe Sleep in Childcare, Lead Poisoning Facts, Guardian and California Megan’s Law (www.meganslaw.ca.gov).

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, deficiencies were cited; see LIC809D.

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.

Exit interview conducted and report was reviewed with Director, Ivette Martinez. A copy of this report, along with Appeal Rights (LIC9058), were provided. A Notice of Site Visit was given and must remain posted for 30 days. LPA observed that the Notice of Site Visit was posted during the inspection. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Cindy Meier
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023

LIC809 (FAS) - (06/04)

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