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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701061
Report Date: 04/19/2023
Date Signed: 04/19/2023 03:49:45 PM


Document Has Been Signed on 04/19/2023 03:49 PM - 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:VINE LEARNING CENTER, THEFACILITY NUMBER:
376701061
ADMINISTRATOR:ANA LOPEZFACILITY TYPE:
850
ADDRESS:2130 ULRIC STREETTELEPHONE:
(858) 974-1222
CITY:SAN DIEGOSTATE: CAZIP CODE:
92111
CAPACITY:108CENSUS: 76DATE:
04/19/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Ana LopezTIME COMPLETED:
04:00 PM
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On 4/19/23 at 3:30 PM, Licensing Program Analyst (LPA) Keturah Lane conducted an unannounced case management visit for the purpose of delivering an amended report. Upon arrival, LPA met with Director Ana Lopez and toured the facility. Census was as follows:
Classroom Monkeys: 19 children with staff members Ebone Singleton & Elizabeth Carpio
Classroom Ladybugs: 21 children with staff members Angie Hernandez & Michelle Leon
Classroom Bumblebees: 19 children with staff members Mariah Ossmen & MIchelle Tucker
Classroom Butterflies: 17 children with staff members Daneila Navaretta & Patricia Villalba

The amended report (LIC9099-D) includes one Type A deficiency that was cited on 4/17/23. LPA advised facility representative, Ana Lopez, that the amended report (LIC9099-D) must be posted for 30 consecutive days as there is an immediate risk to the health, safety and personal rights of children in care. Also, LPA Lane informed facility representative to provide a copy of the amended report (LIC9099-D) to all parents/guardians of children currently enrolled by the next business day or the next day 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 Ana Lopez. Notice of Site visit was posted 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: 04/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2023
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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