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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105011
Report Date: 07/14/2022
Date Signed: 07/14/2022 11:47:44 AM

Document Has Been Signed on 07/14/2022 11:47 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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:GOLDEN POPPY PRESCHOOL & INFANT CENTERFACILITY NUMBER:
376105011
ADMINISTRATOR:SARAH KORNIJCZUKFACILITY TYPE:
830
ADDRESS:3422 TRIPP COURTTELEPHONE:
(858) 794-9130
CITY:SAN DIEGOSTATE: CAZIP CODE:
92121
CAPACITY: 44TOTAL ENROLLED CHILDREN: 44CENSUS: 8DATE:
07/14/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Heather Harris TIME COMPLETED:
12:00 PM
NARRATIVE
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On 7/14/22 at approximately 10:00 AM, Licensing Program Analyst (LPA) Annette Sutherland conducted an unannounced case management inspection. LPA was met at the entry point by Director Heather Harris. LPA introduced herself, displayed her department identification and explained the purpose of the visit. The purpose of this visit was to follow up on a unusual incident report dated 7/11/22. Director provided a tour of the facility. LPA observed the infant Bear Room within ratio & capacity 8:2. Staff present had criminal record clearances and were associated.

The infant classroom was toured to ensure safety and that cribs are approved and compliant with regulations. The cribs in the infant room are Safe T-side Cribs. LPA observed that there are 3 broken cribs labeled “BROKEN” and are only used for none mobile infants. Director stated that she will transition mobile infants to mats and cots and already ordered 7 new cribs to replace older cribs without the flip down gate. LPA also inquired about the nap supervision and sleep log documentation. Director stated that they do check on sleeping infants every 15 minutes but were not logging their sleep. LPA provided Safe Sleep regulation and log to be implemented.

See 809D for Deficiencies Cited

LPA Annette Sutherland informed Director Heather Harris that this report dated 7/14/22 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is immediate risk(s) to the health, safety, or personal rights of children in care.

Continued on LIC 809C

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2022
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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Document Has Been Signed on 07/14/2022 11:47 AM - It Cannot Be Edited


Created By: Annette Sutherland On 07/14/2022 at 11:03 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: GOLDEN POPPY PRESCHOOL & INFANT CENTER
FACILITY NUMBER: 376105011

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/14/2022
Section Cited
CCR
101223(a)(2)

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Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights....(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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Director provided receipt of proof that new slatted cribs were purchased on 7/12/22. They will arrive on 7/18/22. She will no longer use the broken cribs and will transition mobile infants to mats or cots.
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This requirement is not met as evidenced by: LPA observed broken cribs in infant room and Director stated that they are used for non mobile infants.
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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:Monica Cuddy
LICENSING EVALUATOR NAME:Annette Sutherland
LICENSING EVALUATOR SIGNATURE:
DATE: 07/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/14/2022


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Document Has Been Signed on 07/14/2022 11:47 AM - It Cannot Be Edited


Created By: Annette Sutherland On 07/14/2022 at 11:25 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: GOLDEN POPPY PRESCHOOL & INFANT CENTER
FACILITY NUMBER: 376105011

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/14/2022
Section Cited
CCR
101429(a)(C)

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101429 Responsibility for Providing Care and Supervision for Infants (C) Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Date. Infant’s name.Time of each 15-minute check. Initials of staff person who
conducted each check.
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Director will implenent safe sleep regulations and log infants sleep as of today and will submit proof to LPA via email (annette.sutherland@dss.ca.gov) by 7/20/22.
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This requirment was not met as evidenced by : Director stated that staff is supervising infants but has not been logging their sleep.
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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:Monica Cuddy
LICENSING EVALUATOR NAME:Annette Sutherland
LICENSING EVALUATOR SIGNATURE:
DATE: 07/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/14/2022


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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: GOLDEN POPPY PRESCHOOL & INFANT CENTER
FACILITY NUMBER: 376105011
VISIT DATE: 07/14/2022
NARRATIVE
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Also, LPA Annette Sutherland informed the Director Heather Harris to provide a copy of this licensing report dated 7/14/22 that documents any Type A citation(s) 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 the Director , Heather Harris. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022
LIC809 (FAS) - (06/04)
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