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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701061
Report Date: 04/17/2023
Date Signed: 04/17/2023 02:50:05 PM


Document Has Been Signed on 04/17/2023 02:50 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: 57DATE:
04/17/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Claudia GuardadoTIME COMPLETED:
09:30 AM
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On 4/17/23 at 8:20 AM, Licensing Program Analysts (LPAs) Keturah Lane and Gerald Poindexter conducted an unannounced case management visit to follow up on an unusual incident that was reported 12/14/22. Upon arrival, LPAs met with Claudia Guardado and toured the facility. Census was as follows:

Classroom Monkeys: 17 children with staff members Janet Cintora, Ebone Singleton & Elizabeth Carpio
Classroom Ladybugs: 12 children with staff members Angie Hernandez & Gabina Merlin
Classroom Bumblebees: 9 children with staff members Mariah Ossmen & Maria Cabrera
Classroom Butterflies: 13 children with staff members Daneila Navaretta & Michelle Tucker
Classroom Dragonflies: 6 children with staff member Martha Patricia Villalba

The incident reported involved a child (C2) that was injured on the playground. During this visit LPAs observed playground area and conducted interviews with staff and children. LPAs obtained incident and medical reports from the facility. Due to insufficient information available at this time, the reported unusual incident needs further follow up.

Exit interview conducted and report was reviewed with facility representative Director Ana Lopez. A notice of site visit was provided 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: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/17/2023
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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