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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701220
Report Date: 08/05/2021
Date Signed: 08/05/2021 10:07:18 AM

Document Has Been Signed on 08/05/2021 10:07 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:PLAYHOUSE PRESCHOOL FOREVER YOUNGFACILITY NUMBER:
376701220
ADMINISTRATOR:ANNA LOPEZFACILITY TYPE:
850
ADDRESS:7045 FORUM STREETTELEPHONE:
(858) 279-2016
CITY:SAN DIEGOSTATE: CAZIP CODE:
92111
CAPACITY: 78TOTAL ENROLLED CHILDREN: 0CENSUS: 24DATE:
08/05/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Shelley McDoleTIME COMPLETED:
10:15 AM
NARRATIVE
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On 8/5/21 @ 9:00AM, LPA Nancy Diaz conducted an unannounced case management inspection. LPA met with Shelley McDole, licensee. Upon arrival, LPA observed 7 children with staff Arianne Sanchez (6 preschool children and one school-age child). Mrs. McDole stated that she was included in the ratio, however; she was inside the building and the children were co-mingled outside (in the play area).

Type B deficiencies were cited today. Type B deficiency if not corrected posed a potential risk to the health, safety and personal rights of children in care.

An exit interview was conducted with Ms. Shelley McDole. A copy of this report and appeal rights were provided. Ms. McDole's signature acknowledged receipt of the report and appeal rights.

A notice of site visit was observed posted. This notice shall remain posted for 30 days.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 08/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/05/2021
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 08/05/2021 10:07 AM - It Cannot Be Edited


Created By: Nancy Diaz On 08/05/2021 at 09:37 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: PLAYHOUSE PRESCHOOL FOREVER YOUNG
FACILITY NUMBER: 376701220

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/05/2021
Section Cited
CCR
101161(a)

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LIMITATIONS ON CAPACITY.A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.
This regulation was not met as evidenced by:
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THIS WAS CORRECTED IMMEDIATELY. Ms. McDole removed the one school-age child and moved the one child to the school-age room. Another school-age child arrived during the inspection.
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Based on LPA's observation, upon arrival Nancy Diaz observed 7 children with staff Arianne Sanchez (6 preschool and 1 school-age child). Preschool and school-age children we co-mingled in the play area.
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Ms. McDole stated that school-age children will not be comingled with the preschool children.
Type B
08/13/2021
Section Cited
CCR101212(b)

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REPORTING REQUIREMENTS. The name of the child care center director, and any fully qualified teacher(s) designated to act in the child care center director's absence, shall be reported to the Department within 10 days of a change of child care center director or designee(s).
This requirement was not met as evidenced by:
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Ms. McDole shall submit a designation of the new site director with required documents (copy of resume/job application; transcript; photo ID; CPR/First Aid certificate; Preventing Lead Poisoning course completion; LIC 500 & LIC 610).
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Based on LPA's review of records, Ms. McDole failed to notify the department with the change of director. Sherrie Foster was designated as director and this change was not reported to the department.
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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:Tashima Daniel
LICENSING EVALUATOR NAME:Nancy Diaz
LICENSING EVALUATOR SIGNATURE:
DATE: 08/05/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/05/2021


LIC809 (FAS) - (06/04)
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