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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600056
Report Date: 02/17/2021
Date Signed: 02/17/2021 02:08:16 PM

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:KLASSIC KIDS DAY CARE - JERABEKFACILITY NUMBER:
376600056
ADMINISTRATOR:KIRA BREMSETHFACILITY TYPE:
840
ADDRESS:10050 AVENIDA MAGNIFICATELEPHONE:
(858) 265-9971
CITY:SAN DIEGOSTATE: CAZIP CODE:
92131
CAPACITY:100CENSUS: 9DATE:
02/17/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Kira BremsethTIME COMPLETED:
02:10 PM
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On 02/17/2021 at 12:45pm, Licensing Program Analysts (LPAs) Selina Siao and Patrick Ma conducted an unannounced virtual visit to follow-up on an alleged personal rights incident that occurred on 01/27/2021. Due to COVID-19, an unannounced tele-inspection was conducted using Face Time to tour the facility with Director, Kira Bremseth.

The incident involved a day care child who had an unexplained bruise on the arm. Facility representative reported the incident on the day that the facility found out about the alleged incident. Interviews were conducted with several staff members and confidential information was obtained.

The following ratios were observed today: 9 children with staff members Jihan Sharif, Nicolas Jimenez and Cynthia Bavaro. Appropriate ratios were observed today.

An exit interview was conducted, and appeal rights were provided to facility representative. A notice of site visit was provided and to be posted at the facility for 30 days and failure to keep it posted will result in a $100 civil penalty. A copy of this report, LIC9102 and appeal rights (LIC 9058 01/16) were reviewed during inspection and will be e-mailed to Director. Director was advised that acknowledgement of the receipt of the report is to be received within twenty-four hours.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2021
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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