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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701138
Report Date: 09/29/2021
Date Signed: 09/29/2021 02:19:06 PM

Document Has Been Signed on 09/29/2021 02:19 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:DOT TO DOTFACILITY NUMBER:
376701138
ADMINISTRATOR:ADRIANA RIVERAFACILITY TYPE:
850
ADDRESS:12160 ALTA CARMEL COURTTELEPHONE:
(858) 485-1978
CITY:SAN DIEGOSTATE: CAZIP CODE:
92128
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: 41DATE:
09/29/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Samantha HowellTIME COMPLETED:
02:25 PM
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On 09/29/2021 at 12:36pm, Licensing Program Analyst (LPA), Selina Siao conducted an unannounced case management inspection. The purpose of today's inspection is to address a concern regarding staff's qualification. Upon arrival, LPA met with current Director Samantha Howell. LPA conducted a tour of the four classrooms and the following ratios were observed: Roots class had 10 children napping supervised by staff Karen Vargas and teacher Taylor White. Buds class (Pre Kinder) had 11 children that just finished eating lunch and are lining up to use the restroom supervised by teacher Diana Ing and teacher aide Atefeh Negahbanzadeh. Stems class had 12 children getting ready to nap and are supervised by teachers Lily Arango and Taylor Pearson. Sprouts class had 8 children napping on cots and are supervised by teachers Mercedes Stevens and Linda Sassano.

LPA reviewed all the teachers transcripts during today's inspection. Facility understands that teachers aide responsibilities and duties.


No citation issue. A notice of site visit was posted during today's inspection and it must remain posted for 30 days. Failure to keep the it posted could result in civil penalty of $100.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2021
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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