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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376701404
Report Date: 09/22/2021
Date Signed: 09/22/2021 02:59:28 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/05/2021 and conducted by Evaluator Nancy Diaz
COMPLAINT CONTROL NUMBER: 51-CC-20210805102719
FACILITY NAME:PLAYHOUSE PRESCHOOL INFANT CENTERFACILITY NUMBER:
376701404
ADMINISTRATOR:ALICIA PEREZFACILITY TYPE:
830
ADDRESS:6545 BALBOA AVENUE, SUITE BTELEPHONE:
(858) 279-2009
CITY:SAN DIEGOSTATE: CAZIP CODE:
92111
CAPACITY:43CENSUS: 12DATE:
09/22/2021
UNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Alicia PerezTIME COMPLETED:
02:40 PM
ALLEGATION(S):
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Facility is not taking precautions for Covid-19.
INVESTIGATION FINDINGS:
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On 9/22/2021 @ 1:40PM, LPA N. Diaz conducted an unannounced inspection in reference to the above allegations. The purpose of this inspection was to deliver the findings to the above allegation. LPA met with Alicia Perez, Site Director. Observed present today were 7 infants and 5 toddlers.
Based on information obtained during LPA's interviews with staff and parents of children in care and records review, LPA determined that the preponderance of evidence has been met. Director failed to notify the department or the parents of children in care that a child in care and a staff were tested positive for COVID-19. There is enough supporting information to prove the above allegation is SUBSTANTIATED.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 51-CC-20210805102719
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: PLAYHOUSE PRESCHOOL INFANT CENTER
FACILITY NUMBER: 376701404
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/22/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/16/2021
Section Cited
CCR
101212(g)(1)
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REPORTING REQUIREMENTS
The licensee shall report to the local health officer all outbreaks or suspected outbreaks...

This requirement was not met as evidenced by:
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This was corrected immediately: Mrs. Perez notified the Health Department on August 10, 2021 and was advised to quarantine one staff who was not vaccinated. Staff returned from quarantine on Aug. 16, 2021. No other children or staff tested positive for COVID-19. Ms. Perez also completed an Unusual incident report (LIC 624) and submitted to the department immediately. All children in care were tested and all returned negative.
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Based on interviews with staff & parents, it was determined that a child in care tested positive on 7/18/21 and a staff tested positive on 7/28/21. Ms. Perez stated that she was not aware that these incidents are reportable. Ms. Perez failed to notify the parents of children in care; Licensing and Health Department regarding positive cases of COVID-19.
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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.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
LIC9099 (FAS) - (06/04)
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