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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374845327
Report Date: 07/28/2021
Date Signed: 07/28/2021 12:47:11 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:PEPPERTREE MONTESSORIFACILITY NUMBER:
374845327
ADMINISTRATOR:GARCIA, LYNNFACILITY TYPE:
830
ADDRESS:427 COLLEGE BLVD, STE ITELEPHONE:
(760) 940-1931
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY:40CENSUS: 29DATE:
07/28/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Lynn GarciaTIME COMPLETED:
12:50 PM
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Licensing Program Analysts (LPAs) James Wilkerson & Joanne Domingo arrived at this facility for another reason other than an Annual inspection. LPAs reviewed staff files and it was discovered that there was a staff member who did not have a current TB test clearance prior to being hired. There is documentation in the file that indicates that the staff member was aware of the requirement on 5/01/19, however, the staff member failed to obtain a current TB test clearance. The staff member is currently employed but has not been at the facility since March 2021.

A review of the staff files was conducted and staff were hired based on their ECE unit qualifications of Aide, Floater, Assistant Teacher, and Teacher. Of the staff files reviewed, six staff members no longer are employed.

A Technical Advisory Notice was issued during this visit.

An exit interview was conducted and a copy of this report was provided to Ms, Garcia on this date.

A copy of this report must be made available to the public, upon request for three years.
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: James WilkersonTELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021
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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