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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700569
Report Date: 06/30/2025
Date Signed: 06/30/2025 12:28:33 PM

Document Has Been Signed on 06/30/2025 12:28 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:WILLOW GROVE PRESCHOOLFACILITY NUMBER:
376700569
ADMINISTRATOR/
DIRECTOR:		SUSAN CAMPIONFACILITY TYPE:
850
ADDRESS:14727 VIA AZULTELEPHONE:
8586736526
CITY:SAN DIEGOSTATE: CAZIP CODE:
92127
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 16DATE:
06/30/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:18 AM
MET WITH:Kristie SpillaneTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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On 06/30/25 LPA Evelyn Reyes and LPA Renita Rodriguez made an unannounced visit to follow up on self reported incident, received on 5/23/25. Upon entry,LPAs met with Preschool Operations Supervisor, Kristie Spillane,and explained purpose of the visit. LPAs observed appropriate ratios with 37 children and 7 staff. LPA conducted interviews, made a confidential names list, observed the playground, and received a copy of the children's roster.

On 5/22/25 Staff S1 observed child C1 eat breakfast between the time frame of 8:45 a.m. to 9:00 a.m. The breakfast was provided by the school, from a monthly announced menu. The items served included waffles, fruit, and 2 % milk. Kellogg's Eggo Waffles ingredients were wheat, soy, eggs, and milk. Child is not known to have allergies to the items served. After breakfast C1 went outside for field day scheduled. S1 observed C1 playing and running on turf grass. S1 observed and heard Staff S2 speaking about C1 standing alone complaining about eye swelling. S2 asked other staff to look at the child’s eyes for a second opinion. S2 determined that C1 should be taken to the health office. S2 was instructed by Health Technician S3 to return the child to the classroom and keep the child under observation. Upon returning the child to the classroom, S2 noticed C1 to develop skin irritation with hives. Health technician approached S2 in the classroom to see how C1 was doing and asked to have the child return to health office. The Preschool Operations Supervisor S4 was contacted by health tech S3 to share symptoms of C1, and the decision was to call the paramedics. Paramedics arrived at 10:44 a.m. Preschool Operations Supervisor accompanied C1 to hospital and arrived at 11:00 a.m. Parents were contacted and arrived at hospital. C1 was released from hospital to their parents at 1:56 p.m. Medical directives were not provided and C1 returned to school on 5/27/25.

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NAME OF LICENSING PROGRAM MANAGER: Renesha Askew
NAME OF LICENSING PROGRAM ANALYST: Evelyn Reyes
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/30/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: WILLOW GROVE PRESCHOOL
FACILITY NUMBER: 376700569
VISIT DATE: 06/30/2025
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LPA's observed child at school present on 6/30/25 participating in activities.

No deficiency cited.

Exit interviews conducted and report was reviewed with the Preschool Operations Supervisor, Kristie Spillane. A notice of site visit was given and must remain posted for 30 days.
NAME OF LICENSING PROGRAM MANAGER: Renesha Askew
NAME OF LICENSING PROGRAM ANALYST: Evelyn Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2025
LIC809 (FAS) - (06/04)
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