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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370806515
Report Date: 11/03/2022
Date Signed: 11/03/2022 02:57:07 PM

Document Has Been Signed on 11/03/2022 02:57 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:CAJON VALLEY STATE PRESCHOOL - JOHNSONFACILITY NUMBER:
370806515
ADMINISTRATOR:CHRISTINA WESLEYFACILITY TYPE:
850
ADDRESS:500 WEST MADISON AVENUETELEPHONE:
(619) 441-6149
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 16DATE:
11/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Josephine Bauer and Johanna MellosTIME COMPLETED:
02:00 PM
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On 11/3/22, Licensing Program Analyst (LPA), Tyra Block, conducted an unannounced annual inspection. Present were 14 children and 3 staff in the AM session and 18:4 in PM session. LPA met with Josephine Bauer and Johanna Mellos.
The indoor and outdoor of the facility was inspected. They were operating within licensed capacity and ratio limitations and children were observed to be under visual supervision. The classroom and restrooms have adequate lighting, heating, and ventilation. All floors appeared to be safe and clean. Furniture, children's cubbies, toys and napping equipment appeared to be in good condition. Some children bring water bottles and water is available indoors and outdoors for them to be refilled, cups are also available. Trash cans have tight-fitting cover. Disinfectants, cleaning solutions and other hazardous items are stored inaccessible to children. Medication policies and procedures were reviewed. Breakfast and lunch are provided by the school, menus are posted monthly. All food was inspected and protected from contamination. Sign in/out sheets were reviewed showing parent/guardian’s signature and time of day recorded. The surface of the outdoor activity space is maintained in a safe condition with sufficient mulch to cover areas under climbing structures and swings. Drinking water is available inside the classrooms and outdoor play area. There are no bodies of water or weapons present on the premises. The last disaster drill was conducted and documented on 6/8/22. The fire extinguisher (2A10BC, last inspected by fire department 4/18/22) and carbon monoxide detector meet regulation and are operable. The area near the sink in the class and school office is designated for use by children who are ill. A sample of children records, including medical assessment, identification and emergency information were reviewed and found to be in order. Staff's records were reviewed. At least one person is available at all times with current CPR and First Aid certifications. All facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Tyra Block
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2022
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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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: CAJON VALLEY STATE PRESCHOOL - JOHNSON
FACILITY NUMBER: 370806515
VISIT DATE: 11/03/2022
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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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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 and facility representative discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.
Community Care Licensing WEB SITE: http://www.ccld.ca.gov

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.

An exit interview was conducted with facility representative, Johanna Mellos and Notice of Site Visit was provided and must be posted for 30 days.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Tyra Block
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
LIC809 (FAS) - (06/04)
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