<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600145
Report Date: 03/03/2023
Date Signed: 03/03/2023 12:34:03 PM

Document Has Been Signed on 03/03/2023 12:34 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:ALEXA'S PLAYCFACILITY NUMBER:
376600145
ADMINISTRATOR:NORA CAMACHOFACILITY TYPE:
850
ADDRESS:3685 KEARNY VILLA ROADTELEPHONE:
(858) 966-8555
CITY:SAN DIEGOSTATE: CAZIP CODE:
92123
CAPACITY: 92TOTAL ENROLLED CHILDREN: 92CENSUS: 57DATE:
03/03/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Nora CamachoTIME COMPLETED:
12:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 3/3/23 at 11:20 AM, Licensing Program Analyst (LPA) Keturah Lane conducted an unannounced case management visit to follow up on an unusual incident self-reported by the facility on 2/21/23. Upon arrival, LPA met with Director Nora Camacho and toured the facility. LPA observed the following census at the facility:

Shark Classroom: 13 children with 4 staff members
Dolphin Classroom: 13 children with 3 staff members
Octopus Classroom: 12 children with 3 staff members
Walrus Classroom (toddler option): 8 toddlers with 4 staff members
Whales Classroom (toddler option): 11 toddlers with 4 staff members

Total census of 57 children today. LPA observed appropriate ratio, capacity and supervision during the inspection. Incident reported involved a child left unattended for approximately 5-7 minutes on the playground. At this visit, LPA interviewed Director, a staff member and observed the area where the incident occurred. Due to staff mis-communication, it was determined the child was accidentally left in a licensed area of the playground and was not in immediate danger. Director stated she retrained staff on census counts and transitions.

Pursuant to Title 22 of the CA Code of Regulations, the following Type B deficiency was cited (refer to LIC 809-D).

Exit interview conducted and report was reviewed with facility representative Director Nora Camacho. A notice of site visit was provided and must remain posted for 30 days.

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE: DATE: 03/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2023
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 03/03/2023 12:34 PM - It Cannot Be Edited


Created By: Keturah Lane On 03/03/2023 at 12:03 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: ALEXA'S PLAYC
FACILITY NUMBER: 376600145

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/10/2023
Section Cited
CCR
101229

1
2
3
4
5
6
7
101229 Responsibility for Providing Care and Supervision (a) the licensee shall provide care and supervision as necessary to meet the children’s needs. (1) No child shall be left without the supervision of a teacher at any time…supervision shall include visual observation. This requirement was not met as evidenced by…
1
2
3
4
5
6
7
Director stated she retrained staff regarding census counts during transitions and maintaining ratio. Director stated they will use a walkie talkie system for questions and assistance rather than staff leaving the classroom to bring a child to the office. Director stated she will provide proof of the staff training with agenda to LPA via e-mail by 3/10/23 along with staff attendance sign-in sheet.
8
9
10
11
12
13
14
Based upon unusual incident report received and interview with Director and one staff member, a child was left alone for approximately 5-7 minutes on the playground which is a potential health, safety and personal rights risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Monica Cuddy
LICENSING EVALUATOR NAME:Keturah Lane
LICENSING EVALUATOR SIGNATURE:
DATE: 03/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/03/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2