Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701070
Report Date: 04/10/2018
Date Signed 04/16/2018 01:33:02 PM

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:NATIVITY PRESCHOOL, THEFACILITY NUMBER:
376701070
ADMINISTRATOR:CHRISTINE GRUENFACILITY TYPE:
850
ADDRESS:6309 EL APAJO ROADTELEPHONE:
(858) 756-6763
CITY:RANCHO SANTA FESTATE: CAZIP CODE:
92067
CAPACITY:23CENSUS: 15DATE:
04/10/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:28 AM
MET WITH:Christine GruenTIME COMPLETED:
01:25 PM
NARRATIVE
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THIS IS AN AMENDED REPORT.

Licensing Program Analyst, Rita Magana was on site to conduct an annual/random inspection. I toured the center classroom and fully fenced play ground. Drinking water was available in and out- doors. All children were under visual supervision by qualified staff. A random review was completed of staff files and children's records. Staff #2's pediatric, CPR/First Aid card will expire on 8/21/2019. The school practiced a fire drill on 7/29/17. Sign in/out sheets were reviewed. The children bring their own lunch meal and snacks. There was no evidence of flies, rats or the like observed. There was no obvious hazards observed on the play ground or within the classroom. Cushioning under the climbing out door structure was ample. There were no bodies of water or weapons on the premises. Medication was locked. All references are to the California Code of Regulations, Title 22, Division 12, Chapters 1 & 2 and/or the Health and Safety Code. The facility is reminded that all violations if not corrected, will have a risk to the Health, Safety, or Personal rights of children in Care. The citations issued are type B, and, represent a potential safety risks.

SUPERVISOR'S NAME: Carl SheltonTELEPHONE: (619) 767-2205
LICENSING EVALUATOR NAME: Rita MaganaTELEPHONE: (616) 767-2213
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2018
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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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: NATIVITY PRESCHOOL, THE
FACILITY NUMBER: 376701070
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/10/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/11/2018
Section Cited
CCR
101170(d)(A)(e)(h)
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Criminal Record Clearance. All individuals subject to a criminal record review shall obtain a clearance as required by the Department. Failure to do so will result in a an immediate civil penalty assessment. A review of the Department's facility personnel summary revealed staff #1 does not have background clearances associated to license 376701070. Staff #1 has worked in the Center since 2017. As such a civil penalty in the amount of $500. ($100 per each of 5 days) is assessed.
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The affected aid will be Livescanned printed as soon as possible? She will not return to the classroom until she has been fingerprinted for CCLD purposes.
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Type A
04/11/2018
Section Cited
HSC
1596.954
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Carbon Monoxide Detector. Each facility shall have at least one Carbon Monoxide detector. The center did not have a Carbon monoxide detector.
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A carbon monoxide detector will be purchased and put in the classroom by 4-11-18. A copy of the purchase receipt will be sent to CCLD.
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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: Carl SheltonTELEPHONE: (619) 767-2205
LICENSING EVALUATOR NAME: Rita MaganaTELEPHONE: (616) 767-2213
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2018
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: NATIVITY PRESCHOOL, THE
FACILITY NUMBER: 376701070
VISIT DATE: 04/10/2018
NARRATIVE
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This is an electronic copy of a handwritten report. Please see facility file for original signatures. The following information regarding ADA was provided: US Department Of Justice (USDOJ) toll-free ADA Information (800) 514-0301 (voice) (800) 514-0383(TTY) and link to publication: Commonly Asked Questions about Child Care Facilities and the ADA, available at: http://www.ada.gov/childqanda.htm Community Care Licensing: WEB SITE: http://www.ccld.ca.gov The report shall remain available at the facility for public review for three years. LIC 9213 was visibly posted today, for 30 days. A Child Care Provider’s Guide to Safe Sleep was reviewed. The licensee was provided a copy of their appeal rights (LIC 9058, 12/15) and their signature on this form acknowledges receipt of these rights. Appeal must be received within 15 days.
SUPERVISOR'S NAME: Carl SheltonTELEPHONE: (619) 767-2205
LICENSING EVALUATOR NAME: Rita MaganaTELEPHONE: (616) 767-2213
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2018
LIC809 (FAS) - (06/04)
Page: 2 of 3