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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105111
Report Date: 01/16/2024
Date Signed: 01/16/2024 11:35:25 AM

Document Has Been Signed on 01/16/2024 11:35 AM - 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: 35CENSUS: 21DATE:
01/16/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Coralito GarciaTIME COMPLETED:
11:45 AM
NARRATIVE
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On 1/16/24, LPA Patrick Ma made a case management visit to amend report delivered on 11/21/23. During the visit, Director, Coralito Garcia was present.

On 11/21/23, a file review was made, child C1 was found missing immunization records. Facility was cited a Type B deficiency on an incorrect report form. Incorrect report was amended and facility is being reissued deficiency on this report.

Deficiency has been correct and immunization are now on file for child C1.

See 809D for deficiency cited.

Exit interview conducted and report was reviewed with the Director 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: 01/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2024
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 01/16/2024 11:35 AM - It Cannot Be Edited


Created By: Patrick Ma On 01/16/2024 at 10:31 AM
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: 01/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/16/2024
Section Cited
CCR
102418(a)

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Immunizations: Prior to admission to a family day care home, children shall be immunized against diseases
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Director has provided missing immunizations as of site visit. Deficiency is cleared.
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Based on records review 1 out of 5 children's files reviewed was missing immunization records which poses/posed a potential health, safety or personal rights risk to 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: 01/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/16/2024


LIC809 (FAS) - (06/04)
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