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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372000016
Report Date: 11/06/2023
Date Signed: 11/06/2023 10:53:12 AM

Document Has Been Signed on 11/06/2023 10:53 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:ALL SAINTS PRESCHOOLFACILITY NUMBER:
372000016
ADMINISTRATOR:DOREEN DUMONTFACILITY TYPE:
850
ADDRESS:6355 RADCLIFFE DRIVETELEPHONE:
(858) 453-5340
CITY:SAN DIEGOSTATE: CAZIP CODE:
92122
CAPACITY: 43TOTAL ENROLLED CHILDREN: 43CENSUS: 34DATE:
11/06/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Doreen DumontTIME COMPLETED:
11:05 AM
NARRATIVE
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On 11/6/23 at 9:15 AM, Licensing Program Analysts (LPAs) Sherylnn Banas and Keturah Lane conducted an unannounced case management visit to follow up on an unusual incident reported by the facility on 10/27/23. Upon arrival, LPAs met with Director Doreen Dumont and toured the facility. Census was 34 children in 4 classrooms with 5 staff members. All staff were cleared and associated to the facility.

On 10/26/23, a child was injured while playing near the play structure and fell on a piece of loose equipment (a slide) that had been removed from an old Little Tykes play house. The piece of equipment was on the ground next to the end of the structure slide and was an immediate tripping hazard. After the incident, the Director immediately removed the loose piece of equipment and disposed of it.

LPAs also observed other playground potential hazards and advised Director to fix or replace the following items (see LIC9102TV). LPAs observed sufficient material for cushioning under the play structure which is age appropriate and securely fixed to the ground. Area has canopies and trees for shade. Children take their water bottles outside for drinking water which can be refilled by classroom Brita filter pitchers. There are no bodies of water at the facility or on the playground

Because the loose piece of equipment the child was injured on was not being used appropriately, the facility is receiving a Type A citation as it was an immediate health and safety risk to the children. See LIC809-D for deficiency cited. (continued on LIC809-C...)
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE: DATE: 11/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: ALL SAINTS PRESCHOOL
FACILITY NUMBER: 372000016
VISIT DATE: 11/06/2023
NARRATIVE
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LPAs Keturah Lane and Sherlynn Banas informed facility representative Doreen Dumont that this report dated 11/6/23 documents 1 Type A citation which shall be posted for 30 consecutive days as there was an immediate risk to the health, safety, or personal rights of children in care.

Also, LPAs Keturah Lane and Sherlynn Banas informed the licensee facility representative to provide a copy of this licensing report dated 11/6/23 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with facility representative Doreen Dumont. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/06/2023 10:53 AM - It Cannot Be Edited


Created By: Keturah Lane On 11/06/2023 at 10:18 AM
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: ALL SAINTS PRESCHOOL
FACILITY NUMBER: 372000016

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/07/2023
Section Cited
CCR
101238.2(d)(2)

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101238.2 Outdoor Activity Space (d) The surface of the outdoor activity space shall be maintained:(2) Free of hazards including, but not limited to, holes, broken glass and other debris...This requirement was not met as evidence by...
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Director immeidately removed and disposed of the loose piece of play equipment (slide) from the playground. Director provided a written statement to LPAs stating that the facility will not use equipment for uses not intended by the manufacturer.
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Based upon LPAs observations and unusual incident reported, there was a loose piece of play equipment (slide) on the ground near the play structure that was being used inappropriately and caused injury to a child when she fell on it, which is an immediate health, safety and personal rights risk to children in care.
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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:Tashima Daniel
LICENSING EVALUATOR NAME:Keturah Lane
LICENSING EVALUATOR SIGNATURE:
DATE: 11/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/06/2023


LIC809 (FAS) - (06/04)
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