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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700075
Report Date: 05/14/2025
Date Signed: 05/14/2025 11:41:55 AM

Document Has Been Signed on 05/14/2025 11:41 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:LIBBY LAKE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
376700075
ADMINISTRATOR/
DIRECTOR:		IRMA AYALAFACILITY TYPE:
850
ADDRESS:489 CALLE MONTECITOTELEPHONE:
(760) 754-1270
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 32DATE:
05/14/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:38 AM
MET WITH:Site Supervisor Irma Ayala TIME VISIT/
INSPECTION COMPLETED:
11:50 AM
NARRATIVE
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 Licensing Program Analyst (LPA) Kelly Gerth conducted an unannounced annual inspection on May 14, 2025 at the above time. LPA met with Site Director Irma Ayala, who provided a tour of the preschool. During the inspection, several key facility items were observed and updated where necessary. These included the facility's license, the Emergency Disaster Plan (LIC610) and Earthquake Preparedness Checklist (LIC9148), the Parent’s Rights Poster (PUB393), Personal Rights (LIC613A), the Child Car Seat Law notice, and the menu.
The facility was found to be operating within the limits stated on its license, and staff-to-child ratios were observed to be 32 children and 6 staff present. Classrooms were adequately equipped with age- and size-appropriate furniture and materials. Site Director Irma Ayala confirmed that no weapons were present on the premises.
There were no accessible bodies of water on-site. Site Director Irma Ayala is aware that any wading pools or similar products must be emptied immediately after use and stored in an upright position. Drinking water was available both indoors and outdoors, Facility uses bottled water and paper cups/children’s water bottles. LPA also verified that lead testing was completed on 12/15/2022 and the next testing is due by 12/2027. The fire clearance was approved on 06/22/2006 by the Oceanside Fire Department.
Medications, when on site, are stored in the site director’s office and inaccessible to children. Disinfectants, cleaning solutions, and other hazardous materials such as paint were not all stored in locations inaccessible to children, all poisons and toxins were not securely locked away, as observed by the LPA during the inspection. Site Director immediately placed locks on the doors/gate to prevent access to all unsafe items. A deficiency will be issued.
The facility’s floors were observed to be safe and clean, and children’s bathroom facilities were sanitary and in proper working condition. The playgrounds were enclosed by a secure, with a tall fence surrounding the perimeter of the center. The fencing included self-closing gates. The outdoor activity areas contained age- and size-appropriate equipment.
NAME OF LICENSING PROGRAM MANAGER: Carlos Martinez
NAME OF LICENSING PROGRAM ANALYST: Kelly Gerth
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/14/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 05/14/2025 11:41 AM - It Cannot Be Edited


Created By: Kelly Gerth On 05/14/2025 at 10:59 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
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: LIBBY LAKE CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 376700075

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/14/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238(g)(1)
Buildings and Grounds
(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. (1) Storage areas for poisons shall be locked.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview the licensee did not comply with the section cited above, where during the inspection LPA observed classroom 2 staff room, farthest corner, to be accessible to children with door unlocked, upon entry an ajar lower cabinet door was open that contained 1 large jug of bleach. Outdoor activity space had an unlocked chain link gate which was accessible to children and contained 4 cans of building/house paint, 1 large jug of bleach, 4 crates of cleaning agents, more than 20 bottles, labeled toxic/keep out of reach of children, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/15/2025
Plan of Correction
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Facility Representative immediatly locked items on 5/14/25 and agreed to submit a plan for the site, which all staff will be presented and sign reciept of, for storing and locking the items, to CCL by COB on POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Carlos Martinez
NAME OF LICENSING PROGRAM MANAGER:
Kelly Gerth
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/14/2025


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: LIBBY LAKE CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 376700075
VISIT DATE: 05/14/2025
NARRATIVE
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The food preparation area was clean, free of litter and pests, and all food was properly stored to prevent contamination. Storage containers for solid waste had tight-fitting covers, which were kept on and in good repair. The sign-in/sign-out records were reviewed and found to be in compliance with regulations. Disaster drills are conducted at least every six months, with the most recent drill occurring on 04/21/2025.
A review of staff and children’s records was conducted as part of this evaluation. Children's records were complete, and staff records confirmed that all present staff met the minimum qualifications for their respective positions. 5 staff files reviewed held on-site held current Pediatric CPR/First Aid certifications, with expiration dates recorded. Both the opening and closing staff members also had valid CPR/First Aid certifications. Site Director Irma Ayala had completed Health and Safety Training on 09/01/22. Additionally, a review of staff records confirmed that all facility staff and other individuals requiring caregiver background checks had received criminal record and child abuse index clearances or exemptions.
Site Director Irma Ayala was reminded that all adults over the age of 18, including employees and volunteers (except as specified in Health and Safety Code section 1596.871), must obtain a criminal record clearance or exemption before their initial presence in the Child Care Center. A civil penalty of $100 per day for up to five days, or up to 30 days for repeat violations, may be assessed for noncompliance.
This facility provides IMS. LPA reviewed the storage of medications and equipment/supplies, as well as children's, personnel, and administrative records. Additional IMS information is available in PIN 22-02-CCP. Site Director Irma Ayala was also provided with information regarding the Americans with Disabilities Act (ADA), including the U.S. Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY). Additional information is available at Commonly Asked Questions about Child Care Centers and the ADA.
Site Director Irma Ayala was informed about MyChildCarePlan.org, a consumer education website that connects families with child care providers and Resource & Referral Agencies (R&Rs) throughout California. Licensing forms and regulations for Child Care Centers are available on the Department’s website at www.ccld.ca.gov. Providers can also subscribe to receive updates by entering their email under "Receive Important Updates" on the website.
NAME OF LICENSING PROGRAM MANAGER: Carlos Martinez
NAME OF LICENSING PROGRAM ANALYST: Kelly Gerth
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: LIBBY LAKE CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 376700075
VISIT DATE: 05/14/2025
NARRATIVE
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LPA reviewed reporting requirements with Site Director Irma Ayala, emphasizing that any unusual incidents or injuries must be reported within 24 hours via phone and within seven days in writing. Reports may be submitted by calling the Duty Officer at (951) 782-4200 or emailing UnusualIncidentReportsDO10@dss.ca.gov.
To improve the quality and value of the inspection process, a survey may be sent to the provided email. The Director is encouraged to complete the survey and provide feedback on the inspection experience. Any questions regarding the inspection process or CARE tools may be directed to inspectionprocess@dss.ca.gov. Additional details about the inspection process can be found at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
On 05/14/25 a search of the California Attorney General - Megan’s Law website was conducted, and no registered sex offenders were found at the facility address. Some offenders may not be subject to public disclosure under state law; however, the Department performs monthly cross-references of all CCLD facility addresses with the Megan’s Law database provided by the California Department of Justice.
The Director was reminded to update and submit the following documents to licensing within 30 days, if applicable:
· LIC 500 Personnel Report
· LIC 610 Emergency & Disaster Plan
· Parent Handbook, Program Curriculum, Admission Policies & Procedures, and Fee Schedule (if changed or more than two years old)
· LIC 309 Administrative Organization (if changed or more than two years old)
· LIC 308 Designation of Administrative Responsibility (if changed or outdated)
See LIC809-D for cited deficiencies cited

A Notice of Site Visit was provided and must remain posted for 30 days. An exit interview was conducted, and this report was reviewed with Site Director Irma Ayala, Appeal rights were discussed and provided during the exit interview.

NAME OF LICENSING PROGRAM MANAGER: Carlos Martinez
NAME OF LICENSING PROGRAM ANALYST: Kelly Gerth
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025
LIC809 (FAS) - (06/04)
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