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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701207
Report Date: 10/19/2022
Date Signed: 10/19/2022 05:35:13 PM

Document Has Been Signed on 10/19/2022 05:35 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:SAN DIEGO CHILDREN'S ACADEMYFACILITY NUMBER:
376701207
ADMINISTRATOR:NADEZDA GUSEVAFACILITY TYPE:
850
ADDRESS:801 GRAND AVENUE, SUITE 7TELEPHONE:
(760) 891-8155
CITY:SAN MARCOSSTATE: CAZIP CODE:
92078
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 24DATE:
10/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Nadezda GusevaTIME COMPLETED:
05:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Leilani Curtis visited the facility to conduct an annual inspection. Upon arrival LPA met with director Nadezda Guseva and proceeded to tour the facility. LPA provided the LIC 125, Entrance Checklist to the director. Also present were a total of 24 children with 3 staff members. The director’s daughter, Licensee Anastasia Golopapenko translated for the director via telephone. The director’s primary language is Russian. Staff member Tatiana Kuznetcova also translated for the director.

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. LPA observed cleaning solutions and ammonia stored on the floor of an unlocked closet. 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. There is no high climbing equipment such as swings or slides. 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.

This facility provides Incidental Medical Services – IMS. An IMS plan is on file with Community Care Licensing. The director states that there are currently no children enrolled who require Incidental Medical Services. 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.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2022
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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Document Has Been Signed on 10/19/2022 05:35 PM - It Cannot Be Edited


Created By: Grace Curtis On 10/19/2022 at 03:03 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: SAN DIEGO CHILDREN'S ACADEMY
FACILITY NUMBER: 376701207

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/19/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 4 out of 4 staff members whose files were reviewed do not have current mandated reporter certification. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/31/2022
Plan of Correction
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The director states that she will have all staff members, including the four staff members present at the time of inspection complete mandated reporter training. The director will send LPA copies of the certificates via email by 10/31/22.
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and employee/staff statement, the licensee did not comply with the section cited above in one out of four staff files reviewed do not contain verification of a health screening or a tuberculosis test. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/31/2022
Plan of Correction
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The director states that the staff member (S2) will obtain a TB clearance and health screening. The director will send LPA a copy of the TB clearance and health screening verification via email by 10/31/22.
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:Tashima Daniel
LICENSING EVALUATOR NAME:Grace Curtis
LICENSING EVALUATOR SIGNATURE:
DATE: 10/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/19/2022 05:35 PM - It Cannot Be Edited


Created By: Grace Curtis On 10/19/2022 at 03:03 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: SAN DIEGO CHILDREN'S ACADEMY
FACILITY NUMBER: 376701207

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/19/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101221(b)(8)(C)
Child's Records
(C) A signed consent form for emergency medical treatment unless the child's authorized
representative has signed the statement specified in Section 101220(f).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in five out of five children's files reviewed did not contain consent for emergency medical treatment (LIC627). This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/31/2022
Plan of Correction
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The director states that she will ensure that all children enrolled have a completed Consent for Emergency Medical Treatment form, LIC627. The director will send copies of the LIC627 for the 5 children (C1-C5) whose files were reviewed to LPA via email by 10/31/22.
Type B
Section Cited
CCR
101229.1(b)
Sign In and Sign Out
(b) The person who brings the child to, and removes the child from, the center shall sign the child in/out.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in two out of 24 children present at time of inspection were not signed in. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/24/2022
Plan of Correction
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The director states that she will send a letter to all parent advising them of sign in/sign out requirements. The director will send LPA a copy of the letter and parent acknowledgement of the sign in/sign out requirements via email by 10/24/22.
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:Tashima Daniel
LICENSING EVALUATOR NAME:Grace Curtis
LICENSING EVALUATOR SIGNATURE:
DATE: 10/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2022


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: SAN DIEGO CHILDREN'S ACADEMY
FACILITY NUMBER: 376701207
VISIT DATE: 10/19/2022
NARRATIVE
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Admission agreement, emergency information and medical assessment forms were reviewed for some children. LPA reviewed five children’s files and all five children were missing the Consent for Emergency Medical Treatment, LIC627. LPA observed that today’s sign in/sign out sheets were missing two parent/guardian signatures. Staff records contain documentation of education, training, and/or experience. One staff member does not have a medical assessment/health screening or TB test on file. The director states that the facility no longer provides meals to children. The children bring meals/lunch from home. LPA reviewed the following with director Guseva: California Department of Public Health Covid-19 Guidance for Child Care Providers and Programs dated 10/11/22. LPA obtained an updated Emergency Disaster Plan for Child Care Centers- LIC610A, Personnel Report-LIC500, a copy of fire drill log and Parent Handbook.

See LIC809D for cited deficiencies.

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 Guseva 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 Guseva. The director’s daughter, Licensee Anastasia Golopapenko translated this report for the director via telephone.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022
LIC809 (FAS) - (06/04)
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