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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105021
Report Date: 01/14/2022
Date Signed: 01/14/2022 02:11:27 PM

Document Has Been Signed on 01/14/2022 02:11 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:
376105021
ADMINISTRATOR:SHELLEY ARMASFACILITY TYPE:
830
ADDRESS:967 CAMINO DEL RIO SOUTHTELEPHONE:
(619) 295-5500
CITY:SAN DIEGOSTATE: CAZIP CODE:
92108
CAPACITY: 21TOTAL ENROLLED CHILDREN: 21CENSUS: 12DATE:
01/14/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Andrea D'AgostinoTIME COMPLETED:
02:15 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 12 infants and 5 staff.

Four staff supervising and caring for children were not associated to the facility.

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

A Notice of Site Visit was provided and must be posted for 30 days. LPA observed the notice being posted.
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 02:11 PM - It Cannot Be Edited


Created By: Tyra Block On 01/14/2022 at 01:26 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: 376105021

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
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/ associate 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 3 staff were not associated to the facility prior to working. This poses a potential health and safety risk to children in care.
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Request Denied
Type B
01/21/2022
Section Cited
CCR101223(a)(2)

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101223(a)(2) Personal Rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
This requirement was not met as evidenced by:
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Director, Andrea, will inform parent sleep sack can not be used in child care without a medical exemption. Center will cease use or have parent bring in medical exemption.
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Based on record review and observation the child was swaddled in a sleeper provided by the parent without a medical exemption on file. This poses a potential helath and safety risk to the child.
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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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