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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700903
Report Date: 11/09/2021
Date Signed: 11/09/2021 02:11:48 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:CHAI ALTMAN INFANT CENTERFACILITY NUMBER:
376700903
ADMINISTRATOR:SHTERNA GOLDSTEINFACILITY TYPE:
830
ADDRESS:16934 CHABAD WAYTELEPHONE:
(858) 451-0455
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:27CENSUS: 2DATE:
11/09/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Paulina Escamilla & Shterna GoldsteinTIME COMPLETED:
02:30 PM
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On 11/09/2021 at 1:30pm, Licensing Program Analyst (LPA) Samantha Clenista and Patrick Ma visited the facility to conduct a case management site inspection. The purpose of this visit is to follow up on a self-reported incident that occurred on 10/13/2021 where Child #1 sustained a mouth injury from tripping and falling in the classroom.

Upon arrival, LPA's met with Assistant Director, Paulina Escamilla and Director, Shterna Goldstein and proceeded to tour the facility. LPA's observed a total of 2 children (observed napping on cots) with 2 staff members. The teacher present that witnessed the incident was interviewed. LPA's observed where/how the incident occurred. Facility stated that the ratio was 2 staff members and 6 children during the incident. Appropriate ratio, capacity and supervision were observed during inspection. Additional documentation regarding the incident was obtained by LPA's. LPA's will complete a review of all related documentation and if any issues or violations are noted, a follow-up inspection will be conducted. No deficiencies are cited facility at this time. Exit interview was conducted. NOTICE OF SITE VISIT IS TO BE POSTED FOR 30 DAYS. LPA's observed Ms. Escamilla post notice of site visit.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha ClenistaTELEPHONE: (619) 818-6740
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021
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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