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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105011
Report Date: 06/07/2023
Date Signed: 06/07/2023 03:27:19 PM

Document Has Been Signed on 06/07/2023 03:27 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: 12DATE:
06/07/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:51 PM
MET WITH:Monique ReycasaTIME COMPLETED:
03:45 PM
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On 6/7/23 at 2:51 PM, Licensing Program Analyst (LPA) Annette Sutherland conducted a case management inspection. The purpose of this visit was to follow up on an unusual incident report dated 6/5/23 and to cite for a personal rights regulation that was discovered due to an investigation conducted for a complaint received. Director provided a tour of the facility. Appropriate ratios were observed . The infant classroom was toured to ensure safety and that the highchairs are compliant with regulations. Facility is currently using 3 wooden highchairs with detachable trays. LPA was able to see that the broken high chair is missing the 4 screws that attach the part that helps keep the child in place. Director stated that when child was placed in the high chair , he was not buckled in, when child moved/rocked the chair the tray fell out with the center part of the high chair, which caused the child to fall out. Director has removed the Broken high chair from the infant room and is currently looking to replace them with lower chairs for infant eating. Facility was cited on 7/14/22 due to using broken cribs and was advised to check and monitor infant equipment which now creates a repeat violation. Facility is also being cited due to a personal rights violation that was discovered during a complaint investigation. There were several witnesses who confirmed staff #1 yells at the children inappropriately for disciplinary purposes.

See LIC 809D for deficiencies Cited for repeat violations with civil penalties

LPA Annette Sutherland informed Director Monique Reycasa that this report dated 6/7/23 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.

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.


Also, LPA Annette Sutherland informed the Director Monique Reycasa to provide a copy of this licensing report dated 6/7/23 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.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2023
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 06/07/2023 03:27 PM - It Cannot Be Edited


Created By: Annette Sutherland On 06/07/2023 at 01:36 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: 06/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/08/2023
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. This poses an immediate risk to the health and safety of the child.
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Director has since removed highchair from infant room. Checked all other high chairs and will purchase new high chair to replace broken high chair. Director will provide written plan on how the facility check on infant furniture and fixtures to prevent this from happening again.
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This requirement is not met as evidenced by: LPA observed broken highchair in infant room. High chair was missing 4 screws.
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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: 06/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/07/2023 03:27 PM - It Cannot Be Edited


Created By: Annette Sutherland On 06/07/2023 at 02:58 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: 06/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/16/2023
Section Cited
CCR
101223(a)(1)

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101223 (a) (1) Personal Rights - “… To be treated with dignity in his/her personal relationship with staff and other persons.” This requirement is not met as evidenced by:

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Director states they will provide personal rights training to staff to include communication with children. A description of training provided along with a sign in sheet will be sent to LPA via email to Annette.sutherland@dss.ca.gov by POC date 6/16/23.
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Based on interviews with multiple parties, On or about March and May 2023, facility staff (S1) was seen and heard yelling at children in care, which poses a potential 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:Monica Cuddy
LICENSING EVALUATOR NAME:Annette Sutherland
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2023


LIC809 (FAS) - (06/04)
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