<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700096
Report Date: 03/11/2022
Date Signed: 03/11/2022 11:18:55 AM


Document Has Been Signed on 03/11/2022 11:18 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:ADAMS STATE PRESCHOOLFACILITY NUMBER:
376700096
ADMINISTRATOR:DECYDERED PINAFACILITY TYPE:
850
ADDRESS:4672 35TH STREETTELEPHONE:
(619) 362-4200
CITY:SAN DIEGOSTATE: CAZIP CODE:
92116
CAPACITY:24CENSUS: 23DATE:
03/11/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Decy PinaTIME COMPLETED:
11:00 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 3/11/2022 at 9:15am, Licensing Program Analyst (LPA), Martha Malane conducted a case management inspection. Upon arrival, LPA met with Director, Decy PIna and proceeded to tour the facility. There were 23 children and five (5) staff present during the inspection.

On 11/30/2022, Licensee Representative submitted an Unusual Incident/Injury Report to the Department alleging a possible personal rights violation. An investigation was conducted by the Department. During the course of the investigation, interviews were conducted with the child in question, daycare staff, daycare parents, and outside agencies. Based on the information gathered, no disclosures were made and no evidence to corroborate the allegation.

No deficiencies cited during today’s inspection.

Exit interview was conducted with, Director, Decy Pina.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha MalaneTELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:
DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/11/2022
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 1