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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701203
Report Date: 07/14/2022
Date Signed: 07/14/2022 12:44:35 PM

Document Has Been Signed on 07/14/2022 12:44 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:HILLSIDE VILLAGE HEAD START CHILD DEVELOPMENTFACILITY NUMBER:
376701203
ADMINISTRATOR:TANIA BELLOFACILITY TYPE:
850
ADDRESS:12979A COMMUNITY ROADTELEPHONE:
(858) 486-1284
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY: 40TOTAL ENROLLED CHILDREN: 16CENSUS: 12DATE:
07/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:TIME COMPLETED:
12:50 PM
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On July 14, 2022 at 8:30 a.m. Licensing Program Analyst (LPA) Leilani Curtis visited the facility to conduct an annual inspection. Upon arrival LPA met with staff member Maribel Lopez and proceeded to tour the facility. LPA provided the LIC 125, Entrance Checklist to Ms. Lopez. The director Tania Bello arrived at the facility at approximately 9:07 a.m. Also present were a total of 12 children in the following classrooms:

Classroom #1: 4 children with 3 staff members
Classroom #2: 8 children with 2 staff members

Appropriate ratios and capacity were observed. Staff members have the required background clearances and are associated to the facility. No excluded individuals are present. Furniture and age appropriate equipment is in good condition indoors and outdoors. Children's toilets and hand washing facilities are sanitary. Rooms are safe and clean. Food preparation area is clean, food and beverages are stored in covered containers at 45 degrees F or less if required, and storage containers for solid waste are covered. Drinking water is readily accessible inside and outside the classroom. All disinfectants, cleaning solutions, and other hazardous items are inaccessible to children through latches and locks. Storage area for poisons is locked. Medications are kept in a safe place inaccessible to children. The outdoor play area is fenced. Playground equipment is in safe condition, free of sharp, loose or pointed parts. The areas around or under high climbing equipment, swings, slides, and similar equipment is cushioned with material that absorbs a fall. The outdoor play area has canopies used for shade. There are no bodies of water or weapons at this facility. Fire drills are being conducted every 6 months. There is an operational carbon monoxide detector at the facility. First Aid/CPR certifications were reviewed and are in compliance
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
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
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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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: HILLSIDE VILLAGE HEAD START CHILD DEVELOPMENT
FACILITY NUMBER: 376701203
VISIT DATE: 07/14/2022
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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Admission agreement, emergency information and medical assessment forms were reviewed for some children. Sign in/sign out sheets are well maintained. Staff records contain documentation of education, training, and/or experience. Menus are posted. LPA reviewed the following with Director Bello: Updates to the California Department of Public Health Guidance for Child Care Providers and Programs PIN 22-07-CCP dated 3/1/22 and the California Department of Public Health Guidance for Child Care Providers and Programs dated 3/12/22. LPA obtained an updated Emergency Disaster Plan for Child Care Centers- LIC610A, Personnel Report-LIC500 and Parent Handbook. The director will provide LPA with an updated Administrative Organization form, LIC309 by 7/29/22.

No deficiencies cited.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
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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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: HILLSIDE VILLAGE HEAD START CHILD DEVELOPMENT
FACILITY NUMBER: 376701203
VISIT DATE: 07/14/2022
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Child Care Providers can now sign up for Quarterly Updates and PINS through the DSS website. Please go to www.ccld.ca.gov and click on Child Care, go under Quick Links and Quarterly Updates, click on “Receive Important Updates” then enter your email address and choose which program(s) you would like to subscribe to and click “subscribe”.

Duty Officer: (619) 767- 2248, Monday thru Friday 8am-5pm.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Director Bello was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Director Bello.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
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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