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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105112
Report Date: 10/20/2023
Date Signed: 10/20/2023 04:59:17 PM

Document Has Been Signed on 10/20/2023 04:59 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 STARS INFANT CENTERFACILITY NUMBER:
376105112
ADMINISTRATOR:ALEXIS SEGREFACILITY TYPE:
830
ADDRESS:511 ENCINITAS BOULEVARD #114TELEPHONE:
(760) 436-5433
CITY:ENCINITASSTATE: CAZIP CODE:
92024
CAPACITY: 9TOTAL ENROLLED CHILDREN: 9CENSUS: 5DATE:
10/20/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Coralito GarciaTIME COMPLETED:
05:10 PM
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On 10/20/23 at 4:30pm, Licensing Program Analyst (LPA) Patrick Ma, visited the facility to conduct a case management site inspection. The purpose of this visit is to follow up on a self-reported incident that occurred on 10/17/23. LPA was already present at the facility for a different purpose. Present at the facility were 5 day care children and 2 staff. Facility was in ratio.

During the visit, LPA’s toured the infant care room, reviewed the facility area where the incident occurred and conducted interviews with the Director. No violations occurred, however, increase safety measures will need to be implemented. Director had already purchased safety products prior to visit but it may not address the issues. Facility will need to provide the department proof of product safety effectiveness within 30 day (11/20/23),

Exit interview conducted and report was reviewed with the facility representative Coralito 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: 10/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2023
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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