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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105011
Report Date: 07/25/2023
Date Signed: 07/25/2023 02:05:18 PM

Document Has Been Signed on 07/25/2023 02:05 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
SAN DIEGO N. CC RO, 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: 33DATE:
07/25/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Monique ReycasaTIME COMPLETED:
12:30 PM
NARRATIVE
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On 7/25/23 at 2:00 PM Licensing Program Analyst (LPA) Annette Sutherland conducted an unannounced Case Management Deficiency visit for the purpose of issuing a deficiency discovered during another investigation. LPA observed C1 sleeping in a stationary seat. LPA met with Director Monique Reycasa. The total census observed was 33.

Deficiency cited on LIC 809 D

Exit interview conducted and report was reviewed with the Director Monique Reycasa. Appeal rights and notice of site visit was given and must remain posted for 30 days
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2023
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 07/25/2023 02:05 PM - It Cannot Be Edited


Created By: Annette Sutherland On 07/25/2023 at 01:45 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: 07/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/26/2023
Section Cited
CCR
101430A(3)E

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101430 Infant Care Activities (A) Staff shall place infants..... (E) If an infant falls asleep before being placed in a crib, staff shall move the infant to a crib as soon as possible. This requirement was not met as evidenced by
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Deficency was cleared at visit. Director will submit training plan on infant sleeping regulations and provide sign in sheet to department by 8/25/23.
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Based on LPA observation C1 was sleeping in a stationary chair. This poses a potential 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:Renesha Askew
LICENSING EVALUATOR NAME:Annette Sutherland
LICENSING EVALUATOR SIGNATURE:
DATE: 07/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/25/2023


LIC809 (FAS) - (06/04)
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