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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701378
Report Date: 02/10/2023
Date Signed: 02/10/2023 12:23:35 PM

Document Has Been Signed on 02/10/2023 12:23 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:COZY CUBS INC.FACILITY NUMBER:
376701378
ADMINISTRATOR:ELIZABETH HANNFACILITY TYPE:
850
ADDRESS:2291 MAIN STREETTELEPHONE:
(760) 787-0612
CITY:RAMONASTATE: CAZIP CODE:
92065
CAPACITY: 78TOTAL ENROLLED CHILDREN: 97CENSUS: 66DATE:
02/10/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Annette KurtenbachTIME COMPLETED:
10:00 AM
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On 2/10/2023 @9:00 AM, Licensing Program Analyst Patrick Ma, made an unannounced Case Management inspection to evaluate the circumstances surrounding a self-reported incident regarding a child injury. At the time of inspection, there were 66 children with 10 staff in 4 classrooms. Facility was within licensed capacity and ratio.

During today's visit, LPA interviewed Staff #1(S1). Previous phone interview was made with the Director Elizabeth Hann. The incident occurred when child #1 (C1) fell on the stairs. The class was coming down the stairs to go to the playground. C1 was holding the rail but tripped and sustained injuries. Proper 12:1 ratio was followed but the teacher was assisting another child at the top of stairs when the child fell. Since the incident, the facility has already implemented a new staff policy and procedure where two teachers, one in the back and one in the front of the line, will be required when 4 or more children are transitioning down on the stairs. Director provided LPA an addendum with the description of the updated policy and procedure regarding transitioning children on the stairs with all current staff signatures signifying they were trained on the new policy. Facility also added cushioning on the lip edge where the child was injured.

No deficiency cited.

Exit interview conducted and report was reviewed with the facility representative Elizabeth Hann. Notice of Site Visit was given and will be posted for 30 days.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Patrick Ma
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2023
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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