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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105111
Report Date: 10/27/2023
Date Signed: 10/27/2023 04:25:58 PM

Document Has Been Signed on 10/27/2023 04:25 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:ENCINITAS SHINING STARSFACILITY NUMBER:
376105111
ADMINISTRATOR:CORALITO GARCIAFACILITY TYPE:
850
ADDRESS:511 ENCINITAS BOULEVARD #114TELEPHONE:
(760) 436-5433
CITY:ENCINITASSTATE: CAZIP CODE:
92024
CAPACITY: 53TOTAL ENROLLED CHILDREN: 53CENSUS: 22DATE:
10/27/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Coralito GarciaTIME COMPLETED:
01:30 PM
NARRATIVE
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On 10/27/23 Licensing Program Analysts (LPA) Patrick Ma and Gerald Poindexter was present at the facility for a different purpose.

During facility tour, Staff Maryam Khazaeli (S1) stated she was a substitute from Child Care Careers. Ms Khazaeli was a substitute for today only, has finger print clearance but was not associated to the facility.

See LIC 809D for deficiency cited.

Exit interview conducted and report was reviewed with the facility representative Corolito Garcia. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Patrick Ma
LICENSING EVALUATOR SIGNATURE: DATE: 10/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2023
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 10/27/2023 04:25 PM - It Cannot Be Edited


Created By: Patrick Ma On 10/27/2023 at 01:48 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: ENCINITAS SHINING STARS
FACILITY NUMBER: 376105111

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/27/2023
Section Cited
CCR
101170(e)(2)

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101170(e)(1) Criminal Record Clearance; All individuals subject to a criminal record review... shall prior to working...(2) Request a transfer of a criminal record clearance. This requirement is not met as evidenced by:
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Director submitted LIC 9182 to LPA during visit with copy of driver license. Deficiency was cleared during visit.
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Based on records review, it was determined that S1 has been working at the facility today prior to obtaining a criminal record clearance, which poses and immediate health and safety risk to the persons 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:Renesha Askew
LICENSING EVALUATOR NAME:Patrick Ma
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2023


LIC809 (FAS) - (06/04)
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