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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376701411
Report Date: 10/01/2024
Date Signed: 10/01/2024 01:40:04 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/05/2024 and conducted by Evaluator Nancy Diaz
PUBLIC
COMPLAINT CONTROL NUMBER: 51-CC-20240905092847
FACILITY NAME:COZY CUBSFACILITY NUMBER:
376701411
ADMINISTRATOR:ELIZABETH HANNFACILITY TYPE:
830
ADDRESS:2291 MAIN STREETTELEPHONE:
(760) 787-0612
CITY:RAMONASTATE: CAZIP CODE:
92065
CAPACITY:24CENSUS: 18DATE:
10/01/2024
UNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Annette KurtenbachTIME COMPLETED:
12:35 PM
ALLEGATION(S):
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Staff are not rinsing the bottles and are returning the bottles to the wrong authorized representative.
INVESTIGATION FINDINGS:
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On 10/1/2024 @ 8:55AM, Licensing Program Analyst (LPA) Nancy Diaz conducted an unannounced inspection to deliver the findings to the above allegation. It was alleged that staff are not rinsing the bottles and that bottles were returned to the wrong authorized representative. LPA spoke with staff in the infant room. It was revealed that staff do rinse the bottles after each use. On one ocassion, staff admitted to sending home a bottle to the wrong parent. It was due to the children having similar names. Staff was immediately contacted by the parent. Staff explained what happened and it appeared that the parent understood the situation and was very forgiving.
Based on the information obtained during interviews and documentation reviewed it is determined that the allegation is valid because the preponderance of the evidence has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12, Chapter number) the deficiency is being cited on the attached LIC 9099D.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/05/2024 and conducted by Evaluator Nancy Diaz
PUBLIC
COMPLAINT CONTROL NUMBER: 51-CC-20240905092847

FACILITY NAME:COZY CUBSFACILITY NUMBER:
376701411
ADMINISTRATOR:ELIZABETH HANNFACILITY TYPE:
830
ADDRESS:2291 MAIN STREETTELEPHONE:
(760) 787-0612
CITY:RAMONASTATE: CAZIP CODE:
92065
CAPACITY:24CENSUS: 18DATE:
10/01/2024
UNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Annette KurtenbachTIME COMPLETED:
12:35 PM
ALLEGATION(S):
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9
Staff sprayed chemicals near child.
INVESTIGATION FINDINGS:
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On 10/1/2024, LPA Nancy Diaz conducted an unannounced inspection to deliver the findings to the above allegation. It was alleged that staff sprayed chemicals near a child. Based on the information obtained during interviews and observation it is determined that the allegations is Unsubstantiated.

Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the above allegation is found to be Unsubstantiated. Exit interview was conducted and report was reviewed with Annette Kurtenbach. A notice of site visit was given and must remain posted for 30 days
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 51-CC-20240905092847
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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
FACILITY NUMBER: 376701411
VISIT DATE: 10/01/2024
NARRATIVE
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Exit interview was conducted with Annette Kurtenbach, Site Director/Licensee. LPA reviewed and provided a copy of this report to Ms. Kurtenbach. Appeal rights and Notice of Site Visit was provided, and LPA observed posting. Licensee is advised it must remain posted for 30 days.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 51-CC-20240905092847
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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
FACILITY NUMBER: 376701411
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/08/2024
Section Cited
CCR
101427(j)(3)
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INFANT CARE FOOD SERVICE. Bottles and dishes provided by the authorized representative shall be rinsed and returned to the authorized representative for sanitizing at the end of each day.
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One staff has been assigned to pack the bottles to each child's bag. There is a back up person in charge when person is not available.
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This requirement was not met as evidenced by: Based on interview with staff, there was an incident sometime in September wherein a child's bottle was sent home to the wrong parent.
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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.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4