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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701404
Report Date: 09/22/2021
Date Signed: 09/22/2021 03:02:36 PM

Document Has Been Signed on 09/22/2021 03:02 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: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: 43TOTAL ENROLLED CHILDREN: 0CENSUS: 12DATE:
09/22/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Alicia PerezTIME COMPLETED:
03:10 PM
NARRATIVE
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On 9/22/2021 @ 2:40PM, LPA Nancy Diaz conducted an unannounced case management inspection. LPA met with Alicia Perez, Site Director. Observed present today were a total of 12 infants and toddlers. Upon arrival LPA observed Ms. Perez supervising 5 toddlers who were napping in the toddler room; 3 infants who were awake in the main infant classroom with staff Lazeeta Wiggers and 4 infants who were napping in the nap room with staff Caitlin Provido.

Type A deficiency and Civil penalty were assessed today. Type A deficiency if not corrected poses an immediate risk to the health, safety or personal rights of children in care.

An exit interview was conducted with Ms. Perez. Appeal rights were discussed. A copy of this report and appeal rights were provided to Ms. Perez. Notice of site visit was observed posted. Notice of Site Visit shall remain posted for 30 days.

Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.
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.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/22/2021 03:02 PM - It Cannot Be Edited


Created By: Nancy Diaz On 09/22/2021 at 02:15 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: 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 A
09/22/2021
Section Cited
CCR
101170(e)(1)

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CRIMINAL RECORD CLEARANCE. (e) All individuals subject to a criminal record review...shall prior to working, residing or volunteering in a licensed facility:(1)Obtain a California clearance...as required by the Department...
This requirement was not met as evidenced by:
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Ms. Perez sent Ms. Provido to obtain a livescan fingerprint clearance today. Ms. Perez is aware that Ms. Provido may not return to work until clearance is received and associated to the facility.
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Based on LPA's observation and Ms. Perez statement, staff Caitlin Provido did not have a fingerprint clearance obtained/or associated to the facility.
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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: 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


LIC809 (FAS) - (06/04)
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