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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701365
Report Date: 11/15/2021
Date Signed: 11/15/2021 02:23:11 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:LA PETITE ETOILE 360 PRESCHOOLFACILITY NUMBER:
376701365
ADMINISTRATOR:JENNIFER NELSONFACILITY TYPE:
850
ADDRESS:4555 PARK BOULEVARDTELEPHONE:
(858) 449-4891
CITY:SAN DIEGOSTATE: CAZIP CODE:
92116
CAPACITY:20CENSUS: DATE:
11/15/2021
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Celine TheanoTIME COMPLETED:
02:30 PM
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On 11/15/2021 at 1:30pm an office meeting was conducted with Licensee, Celine Theano to discuss deficiencies cited and also to amend the report of an Annual Inspection dated 8/25/2021 and a Case Management on 9/8/2021. Present at the meeting was Licensing Program Manager (LPM), Tulam Vu and Licensing Program Analyst (LPA), Martha Malane.
On 8/25/2021 during an Annual Inspection, facility was sited the following deficiencies:
· Type A 101161(a) Limitations on Capacity - did not ensure the conditions and limitations as specified on the license were observed as there were 24 children in attendance and the facility's capacity is for 20
· Type A for 101170(e)(2) Criminal Record Clearance - a staff member did not have a criminal record clearance on file for this facility
· Type B for 101226(e)(3)(A) Health Related Services– expired medication and missing parent consent form
· Type B for 101217(a)(11)(12) Personnel Records – a staff member did not have a TB clearance or Health Screening document on file
· Type B for 101216.1(b)(1)(A) Teacher – Two staff members who were supervising children alone did not have documentation of complete transcripts on file
· Type B for 101212(b) Reporting Requirements – Licensee did not report to the Department the name of the center director

It is noted that licensee corrected four (4) of the six (6) deficiencies in a timely manner. Licensee was granted an extension of 30 days, due by 9/23/2021, to correct 101212(b) Reporting Requirements, however licensee did not submit a complete packet for a qualified director until 10/20/2021. Licensee was also re-cited on 9/8/2021 for failure to correct proper handling of medication. This deficiency was corrected 10/5/2021.

LPM discussed with licensee the above deficiencies. Licensee was provided with the following resources: LIC9095, ccld.childcarevideos.org - Child Care Reporting Requirements, Background Check Requirements for Caregivers and the Duty Line 619-767-2248. Licensee was informed that failure to comply with licensing laws and regulations may result in administrative action against the license. Licensee stated she understood and will comply with all regulations and laws governing Child Care Centers.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha MalaneTELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2021
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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