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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600145
Report Date: 08/05/2022
Date Signed: 08/05/2022 11:40:18 AM


Document Has Been Signed on 08/05/2022 11:40 AM - 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: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: 51DATE:
08/05/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Nora CamachoTIME COMPLETED:
12:15 PM
NARRATIVE
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On 8/5/22 at 10:15 AM, Licensing Program Analyst (LPA) Keturah Lane conducted an unannounced case management visit at the facility. The purpose of the visit was to follow up on a reported unusual incident where 5 children were accidentally served and ingested uncooked chicken nuggets for snack. Upon arrival, LPA Keturah Lane met with Director Nora Camacho and toured the facility. Census was as follows in preschool rooms:

Shark: 11 children with staff members Lara Padrigon, Kati Gimm and Melissa Ramirez
Dolphin: 14 children with staff members Genevieve Askren (Purvis), Katie Benson (Beamer), Renita Ip and Gabriela Torres
Octopus: 11 children with staff members Emily Fuller, Anh Luc and Sarah Doss
The facility also has a toddler option in rooms Walrus and Whales:
Walrus: 8 children with staff members: Elizabeth Gallagher, Diana Maldonado and Ashley Carrillo
Whales: 7 children with staff members: Jamie Gavino, Veronica Lewis, Sarali Saulog and Michelle Leon
Total census for the facility is 51 children.
The incident occurred in the Walrus room on 7/21/22. Parents were notified and children that ingested the chicken were monitored closely the following week. No children appeared to get sick from ingesting the uncooked chicken.

(Continued on LIC-809C...)
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Keturah LaneTELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:
DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/05/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3


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: ALEXA'S PLAYC
FACILITY NUMBER: 376600145
VISIT DATE: 08/05/2022
NARRATIVE
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Director stated that they are going to require staff members prepping and handling snack to get a food handler card through the national restaurant association by the end of the month. Director is also creating a training for the rest of the staff around food storage, food prep and serving food to children. Director stated they will also have food thermometers available to ensure food is fully cooked. Director stated there will be two staff members (another set of eyes) to look for details such as expiration dates, cooking requirements, etc. Director stated a sheet of general reminders and tips were provided to staff members. Director stated she will send documentation that staff have received food preparation training to LPA Lane.

Based upon the seriousness of the incident and immediate health risks that could have occurred to the children, a Type A deficiency was cited (refer to LIC809-D). LPA Lane informed facility representative Director Nora Camacho that the report dated 8/5/22 documents 1 Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health and safety of children in care.

Also, LPA Lane informed the facility representative Director Nora Camacho to provide a copy of this licensing report dated 8/5/22 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC9224), or other written statement, must be placed in the child’s file for verification.

Exit interview conducted and report was reviewed with facility representative Director Nora Camacho. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Keturah LaneTELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 08/05/2022 11:40 AM - It Cannot Be Edited

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: ALEXA'S PLAYC
FACILITY NUMBER: 376600145

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/08/2022
Section Cited

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101227 Food Services -
(a) In child-care centers providing meals to children, the following shall apply: (1) All food shall be safe and of the quality and in the quantity necessary to meet the needs of the children… All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement was not met as evidenced by…
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Based upon duty call and incident report received, licensee did not ensure food was prepared and served in a safe and healthful manner which posed an immediate health and safety risk to children in care.
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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: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Keturah LaneTELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:
DATE: 08/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/05/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3