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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105020
Report Date: 01/14/2022
Date Signed: 01/14/2022 02:09:31 PM

Document Has Been Signed on 01/14/2022 02:09 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:EARLY LEARNERS CHILDREN'S ACADEMYFACILITY NUMBER:
376105020
ADMINISTRATOR:SHELLEY ARMASFACILITY TYPE:
850
ADDRESS:967 CAMINO DEL RIO SOUTHTELEPHONE:
(619) 295-5500
CITY:SAN DIEGOSTATE: CAZIP CODE:
92108
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 37DATE:
01/14/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Andrea D'AgostinoTIME COMPLETED:
01:05 PM
NARRATIVE
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On 1/14/22, Licensing Program Analyst (LPA), Tyra Block, conducted a Case Management- Deficiency visit to address deficiencies observed during a visit concerning another matter. Present at the facility were 37 children and 5 staff.

The floater teacher was not associated to the facility. Director acknowledged the staff has worked here for a couple of months.

See LIC 809-D for Type B deficiency cited during today's visit. A civil penalty was assessed.

A Notice of Site Visit was provided. It must be posted for 30 days. LPA observed it being posted at the facility.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Tyra Block
LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 01/14/2022 02:09 PM - It Cannot Be Edited


Created By: Tyra Block On 01/14/2022 at 12:55 PM
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: EARLY LEARNERS CHILDREN'S ACADEMY
FACILITY NUMBER: 376105020

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/18/2022
Section Cited
CCR
101170(e)(2)

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101170(e)(2)-Criminal Record Clearance: All individuals subject to a criminal record review... shall prior to working, residing or volunteering in a licensed facility: Request a transfer of a criminal record clearance as specified in Section 101170(f). This requirement was not met as evidenced by:
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Director, Andrea, stated she is attempting to register for a guardian account to transfer staff herself. She will ensure staff is associated by POC due date by either completing Guardian registration or submitting Transfer Clearance by fax to regional office.
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Based on record review and interview staff #1 was not associated to the facility. This poses a potential health and safety risk to children in care.
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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:Tashima Daniel
LICENSING EVALUATOR NAME:Tyra Block
LICENSING EVALUATOR SIGNATURE:
DATE: 01/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/14/2022


LIC809 (FAS) - (06/04)
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