376701347-10-7-2025-51-CC-RROZ-DM8SZQ-20251007141931

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376701347
Report Date: 10/07/2025
Date Signed: 10/07/2025 02:19:55 PM

COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/07/2025 02:19 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:	POWAY COUNTRY PRESCHOOL		FACILITY NUMBER:	376701347
ADMINISTRATOR/ DIRECTOR:	DAWN EMIKO RODRIGUEZ		FACILITY TYPE:	850
ADDRESS:	14411 NORWALK LANE		TELEPHONE:	(858) 486-4420
CITY:	POWAY	STATE: CA	ZIP CODE:	92064
CAPACITY: 44	TOTAL ENROLLED CHILDREN: 34	CENSUS: 26	DATE:	10/07/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:20 PM
MET WITH:	Dawn Rodriguez		TIME VISIT/ INSPECTION COMPLETED:	02:39 PM

NARRATIVE

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On 10/7/25 at 1:20 p.m. Licensing Program Analyst LPA Renita Rodriguez made an unannounced case management inspection for a self reported incident that occurred on 9/30/25. LPA met with Director Dawn Rodriguez. Ratios observed today 26 children and 3 staff.

The incident occurred on 9/30/25 at 9:50 a.m. during outdoor activities on the play ground. The ratio during the time of the incident was 10 children and 2 staff. Child C1 was playing on a metal car structure. The child was playing on the structure attempting to sit and stand on it. Staff S1 asked child to not stand on the structure. The area the child was standing on is not for standing. This part of the structure is cylinder in shape. As the child was coming off the structure from the standing position, child forehead hit the structure. The child was crying and there was blood. Staff S1 took child inside the Director's office. The Director placed pressure on the area. Director completed a concussion check. Parent was called and arrived within about 20 minutes to pick up the child. Child was taken for medical evaluation and treatment. The area was glued and bandaged. The child returned to care at the center the next day on 10/1/25 without medical directive.

No deficiencies cited today.

Exit interview conducted and notice of site visit was provided to Director Dawn Rodriguez.

NAME OF LICENSING PROGRAM MANAGER: Renesha Askew
NAME OF LICENSING PROGRAM ANALYST: Renita Rodriguez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025

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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