Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701046
Report Date: 08/09/2017
Date Signed 08/15/2017 10:59:08 AM

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:KIDS ON THE GOFACILITY NUMBER:
376701046
ADMINISTRATOR:EMLYN MARTINEZFACILITY TYPE:
840
ADDRESS:2015 BIRCH ROAD, UNIT 1703TELEPHONE:
(619) 407-7756
CITY:CHULA VISTASTATE: CAZIP CODE:
91915
CAPACITY:53CENSUS: 0DATE:
08/09/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Destiny SzafarskiTIME COMPLETED:
03:10 PM
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THIS IS AN ELECTRONIC COPY OF HAND WRITING REPORT PROVIDED ON 8/9/17 Licensing Program Analyst (LPA) Iman Kayyali visited the facility to conduct an unannounced Annual Random site inspection. Upon arrival LPA met with Administrator Destiny Szafarski, and proceeded to tour the facility. All required notices, forms and license were posted. There were no children present at time of inspection.

Furniture and age appropriate equipment is in good condition. Floors are clean and safe. Backpack storage is available. Bathrooms are safe and sanitary, maintained with operational toilets and faucets with appropriate temperature. Paper towels and toilet paper are available. Bathroom is lighted and has ventilation. Trash cans have tight fitting covers in good repair. Food service area consists of a kitchen which is clean and free of hazards. Children are provided drinking water from an operational water fountain. Adequate food is available for meals and snacks. Cleaning supplies are kept locked and are inaccessible to children. Medication is stored in the kitchen inaccessible to children. There is at least one staff present with a current CPR and First Aid certification. Outdoor play area is a fenced playground with sufficient wood chips for cushioning. Playground equipment is in safe condition and large play equipment is securely fixed to the ground. Area has a canopies used for shade. Last fire drill was conducted on June 27, 2017.

This facility provides Incidental Medical Services (IMS). 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 .LPA reviewed sign in sheets. Personnel records were reviewed for qualifications and immunizations per SB792. Client records were reviewed for LIC 700 (Identification and Emergency Information) and Medical Assessment. All personnel have required criminal record and child abuse index clearances or exemptions. An exit interview was conducted. No deficiencies were observed or cited during today's visit.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Iman KayyaliTELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2017
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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