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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700393
Report Date: 10/25/2019
Date Signed: 10/25/2019 03:16:48 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:LINDA VISTA STATE PRESCHOOLFACILITY NUMBER:
376700393
ADMINISTRATOR:MICHAEL BERAUDFACILITY TYPE:
850
ADDRESS:2772 ULRIC STREETTELEPHONE:
(858) 800-5450
CITY:SAN DIEGOSTATE: CAZIP CODE:
92111
CAPACITY:72CENSUS: 54DATE:
10/25/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:41 PM
MET WITH:Julia Groff TIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA), Rajani Goudreau conducted an unannounced Case Management visit for the purpose of investigating three incidents self-reported by facility occurring on 06/03/19 and 06/06/19. Incident occurring on 06/03/19, reflects Staff #1 (S1) yelled at parent #1 (P1) in front of children in care. Also, on 06/03/19, S1 was in dispute with office staff members where the Police Department was called. Incident occurring on 06/05/19, reflects staff #1 combined two classrooms for a parent and student celebration in the morning. The incidents were self-reported to Community Care Licensing by the facility within a timely manner. Facility was on summer break from June 1st, 2019 to August 26, 2019. New principle effective 08/2019 is Nina Maurucia. Directors packet discussed.

Upon arrival, LPA met with acting principle, Julia Groff. Appropriate ratios and capacity were observed in classrooms #7, #8 and #9 during facility tour. LPA conducted staff interviews. Incidents currently require further investigation at this time.

No deficiencies issued during today’s visit. LPA conducted an exit interview with acting principle. A copy of this report and Notice of Site Visit were left at the facility. LIC9213-Notice of Site Visit must be posted for 30 days from todays date. LPA observed Notice of Site Visit posted prior to exiting facility.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Rajani GoudreauTELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2019
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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