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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701378
Report Date: 07/07/2021
Date Signed: 07/07/2021 04:26:48 PM

Document Has Been Signed on 07/07/2021 04:26 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: 0CENSUS: 41DATE:
07/07/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Elizabeth HannTIME COMPLETED:
04:40 PM
NARRATIVE
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On 7/7/21 at 11:05 AM, Licensing Program Analysts (LPAs) Patrick Ma and Keturah Lane conducted an unannounced case management inspection for the purpose of following up on a self-reported unusual incident. The incident happened 6/29/21 on the playground area and involved inappropriate behavior between two children under a play structure. Upon arrival LPAs met with Director Elizabeth Hann and toured the facility and playground. The following ratios were observed:
· Dinosaurs classroom (3-4 yrs): 13 children with staff members Patricia (Patti) Grassilli and Tara Shelton
· Explorers classroom (2 year olds): 16 children with staff members Jamie Lindenmeyer, Andrea Estrella and Marissa (Alec) Lane
· Grizzlies classroom (4-5 year olds): 12 children with staff members Soleil Rodriguez and Christina Banks

LPAs toured the playground and discovered additional blind spots in the playground area. LPAs advised Director regarding these blind spots and to bring them to the staff members’ attention during supervision. LPAs interviewed children, staff members, parents and Director.

Facility responded appropriately to the incident and reported to Licensing in a timely manner by calling LPA Ma on 6/30/21 and submitting unusual incident report on 7/2/21. Parents of both children were notified and administration consulted with them in separate meetings. Director held a staff meeting with preschool staff to discuss appropriate supervision and updated the policy regarding that. Policy updates included no longer allowing staff to sit while supervising outside. The playground structure was removed. (continued on LIC809-C...)
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE: DATE: 07/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/07/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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
VISIT DATE: 07/07/2021
NARRATIVE
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It was determined that the incident could have been prevented and that it was an immediate health, safety and personal rights risk to the children in care because of lack of supervision.

Today, deficiency cited under Title 22 Division 12 Appeal rights given.
Upon receipt of this report, Director shall post and provide copies of this licensing report to parents /guardian of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. Director to provide Acknowledgement of Receipt of Licensing Reports (LIC 9224) for each child in care and have each parent sign the form that they have received a copy of the report LIC809, LIC809C and LIC809D.
THIS REPORT MUST BE FILED IN FACILITY FILE AND MADE AVAILABLE FOR PUBLIC REVIEW FOR 3 YEARS.

An exit interview was conducted with the Director. The Director was provided a copy of their appeal rights (LIC 9058) along with the report (LIC809, LIC809C, LIC809D) and their signature on this form acknowledges receipt of these rights. The LIC 9213 (Notice of Site visit) was posted during today's visit. Notice of Site Visit must remain posted for 30 days.

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/07/2021 04:26 PM - It Cannot Be Edited


Created By: Keturah Lane On 07/07/2021 at 02:53 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: COZY CUBS INC.
FACILITY NUMBER: 376701378

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/08/2021
Section Cited
CCR
101229(a)

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101229 Responsibility for Providing Care and Supervision - (a) The licensee shall provide care and supervision as necessary to meet the children's needs. This requirement was not met as evidence by...
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Director removed the structure from the playground and updated the supervision policy with staff. Director will submit written supervision policy with staff signatures via e-mail to LPA Lane by 7/8/21.
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Based upon facility reports and LPAs interviews with children, staff, parents and Director it was determined that the incident could have been prevented with proper supervision creating an immediate health, safety and personal rights risk to the 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: 07/07/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2021


LIC809 (FAS) - (06/04)
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