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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701266
Report Date: 05/10/2023
Date Signed: 05/10/2023 04:55:39 PM

Document Has Been Signed on 05/10/2023 04:55 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:ADVENTURE DAYS PRESCHOOLFACILITY NUMBER:
376701266
ADMINISTRATOR:JILL GILESFACILITY TYPE:
830
ADDRESS:10881 TIERRASANTA BOULEVARDTELEPHONE:
(858) 560-5686
CITY:SAN DIEGOSTATE: CAZIP CODE:
92124
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 18DATE:
05/10/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Jill GilesTIME COMPLETED:
05:00 PM
NARRATIVE
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On 5/10/23 at 3:30 PM, Licensing Program Analyst (LPA) Keturah Lane conducted an unannounced case management inspection regarding an unusual incident reported at the facility. LPA met with Director Jill Giles and toured the classrooms. Census was as follows:
  • 10 infants in Jellyfish classroom with staff members: Ms. Shavona Holmes, Ms. Ana Rebelez, Ms. Adriana Ojeda and Ms. Yesenia Nicolai (sub)
  • 8 infants in Sharks classroom with staff members: Ms. Cassie Butler and Ms. Audra Brownlee

While LPA was at the facility for another visit, Director informed LPA about the unusual incident that happened yesterday 5/9/23 where a staff member (S1) yelled at a child in care. Director was informed by a parent who witnessed the incident. The parents of the child were notified. Director provided LPA with written incident report during the visit. LPA interviewed Director and staff regarding the incident. Staff member was relieved of duty and no longer works at the facility.

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 Jill Giles. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2023
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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Document Has Been Signed on 05/10/2023 04:55 PM - It Cannot Be Edited


Created By: Keturah Lane On 05/10/2023 at 03:29 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: ADVENTURE DAYS PRESCHOOL
FACILITY NUMBER: 376701266

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/15/2023
Section Cited
CCR
101223(a)(3)

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101223(a)(3) Personal Rights -
(a) The licensee shall ensure that each child is accorded the following personal rights:
(3)To be free from...intimidation...coercion, threat... This requirement was not met as evidenced by...
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Director immediately suspended and then terminated staff member (S1). Parents were notified of the incident. Director stated she would have a refresher training with infant staff regarding personal rights on 5/12/23 and will send proof of training (agenda and staff sign in sheet) to LPA Lane by 5/15/23
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Based upon staff interviews and incident report received from facility, a staff member yelled in a threatening manner at a child in care which is a potential health, safety and personal rights risk to children 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:Monica Cuddy
LICENSING EVALUATOR NAME:Keturah Lane
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2023


LIC809 (FAS) - (06/04)
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