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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701378
Report Date: 09/06/2024
Date Signed: 09/06/2024 12:02:51 PM

Document Has Been Signed on 09/06/2024 12:02 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:COZY CUBS INC.FACILITY NUMBER:
376701378
ADMINISTRATOR/
DIRECTOR:		ELIZABETH HANNFACILITY TYPE:
850
ADDRESS:2291 MAIN STREETTELEPHONE:
(760) 787-0612
CITY:RAMONASTATE: CAZIP CODE:
92065
CAPACITY: 78TOTAL ENROLLED CHILDREN: 78CENSUS: 42DATE:
09/06/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:31 AM
MET WITH:Elizabeth Hann & Annette KurtenbachTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
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On 9/6/2024 @ 11:16AM, Licensing Program Analyst (LPA) conducted an unannounced case management inspection. LPA met with Site Director Elizabeth Hann & Licensee Annette Kurtenbach.

Observed present today were 14 toddlers and 28 preschool children. The toddler group was observed to be out of ratio.

Type B deficiency was cited today. Type B deficiency if not corrected poses a potential risk to the health, safety or personal rights of children in care.

Exit interview was conducted with Elizabeth Hann. LPA reviewed and provided a copy of the report with Elizabeth Hann/Annette Kurtenbach. LPA also provided a copy of the appeal rights and notice of site visit that has to be posted for 30 days.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2024
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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Document Has Been Signed on 09/06/2024 12:02 PM - It Cannot Be Edited


Created By: Nancy Diaz On 09/06/2024 at 11:36 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: COZY CUBS INC.
FACILITY NUMBER: 376701378

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/06/2024
Section Cited
HSC
1596.956

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The maximum group size with two teachers, or one fully qualified teacher and one aide shall not exceed 12 toddlers.

This requirement was not met as evidenced by:
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Observed corrected today. Ms. Elizabeth Hann stepped in the Toddler room and divided the group. One side with 6 toddlers:1 teacher and other side with 8 toddlers: 1 teacher and 2 aides.
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Based on observation, there were 14 toddlers with 1 fully qualified teacher and 2 aides present today.
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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:Joelle Redding
LICENSING EVALUATOR NAME:Nancy Diaz
LICENSING EVALUATOR SIGNATURE:
DATE: 09/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2024


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