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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700936
Report Date: 12/18/2020
Date Signed: 12/18/2020 08:23:52 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:ASPEN LEAF PRESCHOOLFACILITY NUMBER:
376700936
ADMINISTRATOR:MARIEVA LOZANO-ZAMUDIOFACILITY TYPE:
850
ADDRESS:3518 THIRD AVENUETELEPHONE:
(619) 501-8899
CITY:SAN DIEGOSTATE: CAZIP CODE:
92103
CAPACITY:29CENSUS: 0DATE:
12/18/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
05:17 PM
MET WITH:Howard Wu, Facility RepresentativeTIME COMPLETED:
05:20 PM
NARRATIVE
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Due to the COVID-19 State of Emergency, Licensing Program Analyst (LPA), Marie Hernandez conducted a Tele-Conference case management inspection in conjunction of the complaint investigation of 12/18/2020. LPA met with the Facility Representative, Howard Wu. Per the interviews, staff stated on several occasions they have taken the children to Balboa Park and allowed the children to play on the play structure. The child in question was four years old and was allowed to play on the play structure for ages 5 through 12 years old. However, the park play structure states it is for ages 5 through 12 years old. The staff stated they did not realize the play structure equipment was for ages 5 through 12 years old. The facility is licensed for ages 2 through 5 years old This poses a potential health and safety risk to children in care. The following deficiency was cited per Title 22 Regulations, Section 101239(m)(1) Fixtures, Furniture, Equipment and Supplies - All play equipment and materials used by children shall be age-appropriate.

A copy of the report, and the appeal rights were emailed to the Representative, Mr. Wu. The Representative was advised that acknowledgement of receipt of the report is to be received within 24 hours. NOTE on Facility Signature: SEE FILE FOR ACKNOWLEDGEMENT.
SUPERVISOR'S NAME: Joe CarrascoTELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Marie HernandezTELEPHONE: (619) 767-2244
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2020
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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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: ASPEN LEAF PRESCHOOL
FACILITY NUMBER: 376700936
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/18/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
12/18/2020
Section Cited

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101239(m)(1) Fixtures, Furniture, Equipment and Supplies - All play equipment and materials used by children shall be age-appropriate. The licensee shall provide a variety of age-appropriate equipment, toys and materials in good condition and in sufficient quantity to allow children present to fully participate in planned activities…
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This requirement was not met as evidenced by: Based on the interviews with several staff, on several occasions, they have allowed the child in question, who is age four, to play on the Balboa Park play structure equipment that states for ages 5 through 12 years old. This poses a potential health and safety risk to children in care.
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The Appeal Rights were provided.

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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: Joe CarrascoTELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Marie HernandezTELEPHONE: (619) 767-2244
LICENSING EVALUATOR SIGNATURE:
DATE: 12/18/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/18/2020
LIC809 (FAS) - (06/04)
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