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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105011
Report Date: 05/16/2023
Date Signed: 05/16/2023 02:25:10 PM

Document Has Been Signed on 05/16/2023 02:25 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:GOLDEN POPPY PRESCHOOL & INFANT CENTERFACILITY NUMBER:
376105011
ADMINISTRATOR:MONIQUE REYCASAFACILITY TYPE:
830
ADDRESS:3422 TRIPP COURTTELEPHONE:
(858) 794-9130
CITY:SAN DIEGOSTATE: CAZIP CODE:
92121
CAPACITY: 44TOTAL ENROLLED CHILDREN: 44CENSUS: 41DATE:
05/16/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:28 PM
MET WITH:Monique ReycasaTIME COMPLETED:
01:30 PM
NARRATIVE
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On 5/16/23 at 12:28 PM, Licensing Program Analyst (LPA) Annette Sutherland conducted an unannounced case management inspection.  LPA was met at the entry point by Director Monique Reycasa also present was Assistant Director Miriam Moreno Shellend .  Director provided a tour of the facility. LPA observed the infant Bear Room within ratio & capacity .Staff present had criminal record clearances and were associated. LPA observed a baby bouncing in a baby bouncer in the infant play area. Which poses an immediate risk to the health and safety of children in care.

See LIC 809D for Deficiencies Cited

LPA Annette Sutherland informed Director Monique Reycasa that this report dated 5/16/23 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.

Also, LPA Annette Sutherland  informed the Director Monique Reycasa to provide a copy of this licensing report dated 5/16/23 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 , Monique Reycasa . 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: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2023
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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Document Has Been Signed on 05/16/2023 02:25 PM - It Cannot Be Edited


Created By: Annette Sutherland On 05/16/2023 at 01:47 PM
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: 05/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/16/2023
Section Cited
CCR
101439(d)(2)

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Infant Care Center Fixtures, Furniture, Equipment and Supplies. LPA observed a baby bouncer seat in the bear room. This regulation was violated as evidenced by LPA's observation of a child bouncing in the seat.

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Director Monique immediately removed the bouncer seat during the visit. A written plan of correction will be submitted to the Licensing Program Analyst Annette Sutherland by 5/17/23.
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Based on LPA observation. An infant was in the baby bouncer seat in the bear room. This poses an immediate risk to the health and safety of 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:Monica Cuddy
LICENSING EVALUATOR NAME:Annette Sutherland
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2023


LIC809 (FAS) - (06/04)
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