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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600145
Report Date: 01/31/2022
Date Signed: 01/31/2022 10:59:50 AM

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:ALEXA'S PLAYCFACILITY NUMBER:
376600145
ADMINISTRATOR:NORA CAMACHOFACILITY TYPE:
850
ADDRESS:3685 KEARNY VILLA ROADTELEPHONE:
(858) 966-8555
CITY:SAN DIEGOSTATE: CAZIP CODE:
92123
CAPACITY:92CENSUS: 60DATE:
01/31/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Elizabeth Gallager, Behavior Specialist, Payal Beam, Sr., Director, Developmental Services and Fara Bowles, Administrative AssistantTIME COMPLETED:
11:10 AM
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On 1/31/22 @ 10:00 a.m., Licensing Program Analyst (LPA), Joelle Redding, made an unannounced visit to follow up on a self-reported incident that occurred on 12/17/21, where a child was reported to have touched another during a game on the playground.

LPA spoke with Staff #1 and #2, who were supervising 17 children on the playground at the time of the incident. LPA also spoke with Director, Nora Camacho, via telephone, as she was out off the office today. After the incident, personal boundaries/space and permission and safety were revisited with the children and all staff were reminded to ensure appropriate supervision at all times. LPA observe the playground and noted that there was a good visual in and around the playstructures present.

Ratios were met, supervision was in place, the facility reported timely and responded appropriately. No deficiencies are cited.

NOTICE OF SITE VISIT WAS GIVEN AND WILL REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2022
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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