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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701404
Report Date: 07/15/2021
Date Signed: 07/15/2021 11:55:20 AM

Document Has Been Signed on 07/15/2021 11:55 AM - 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:PATRICIA BOBBFACILITY TYPE:
830
ADDRESS:6545 BALBOA AVENUE, SUITE BTELEPHONE:
(858) 279-2009
CITY:SAN DIEGOSTATE: CAZIP CODE:
92111
CAPACITY: 43TOTAL ENROLLED CHILDREN: 0CENSUS: 9DATE:
07/15/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:58 AM
MET WITH:Patricia BobbTIME COMPLETED:
12:00 PM
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On 7/15/21 @ 9:58AM LPA Nancy Diaz conducted an unannounced case management inspection. LPA met and toured the facility with Patricia Bobb, Site Director. Observed present today were 5 toddlers with staff Rosemarie Mentone and 4 infants with staff Patricia Bobb and Alicia Perez. Licensee, Shelley McDole arrived a few minutes into the inspection.

Ms. Bobb stated that they have a new staff who started about 2 weeks ago. Staff is Lazeeta Wiggers.

Facility do not maintain the 15-minute log for napping infants.

LPA provided the director a copy of Section 101429 - Responsibility for providing care and supervision to infants. LPA also provided the director for a copy of LIC9227 - Individual Infant sleeping Plan.

TYPE A AND B DEFICIENCIES WERE CITED TODAY.

Type A deficiency if not corrected poses an immediate risk to the health, safety and personal rights of children in care.

Type B deficiency if not corrected poses a potential risk to the health, safety and personal rights of children in care.

CIVIL PENALTY WAS ASSESSED.
An exit interview was conducted with lead staff Alicia Perez. A copy of the licensing report and appeal rights were provided. Notice of site visit must be 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: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2021
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 07/15/2021 11:55 AM - It Cannot Be Edited


Created By: Nancy Diaz On 07/15/2021 at 11:12 AM
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: 07/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/15/2021
Section Cited
CCR
101170(e)(2)

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Section 101170(e)(2) CRIMINAL RECORD CLEARANCE. Request a transfer of a criminal record clearance...

This requirement was not met as evidenced by:
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CORRECTED TODAY. Staff fLazeeta Wiggers was associated today via Guardian.
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Based on file review of staff record and fingerprint clearance database, it was determined that facility failed to associate staff Lazeeta Wiggers to the facility. Staff started working at this center on June 28, 2021.
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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: 07/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2021


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/15/2021 11:55 AM - It Cannot Be Edited


Created By: Nancy Diaz On 07/15/2021 at 11:21 AM
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: 07/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/22/2021
Section Cited
CCR
101429(a)(2)(C)

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Section 101429(a)(2)(C) - Responsibility for providing care and supervision for infants. Documentation shall be maintained in the infant’s file and be available to the Department for review.
This regulation was not met as evidenced by:
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Mrs. McDole stated that she will create a log no later than 7/22/2021. She will submit a copy of the log to the department no later than 7/22/2021.
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Based on LPA's observation and review of files, facility is currently not maintaining a log to show that infants are checked every 15 minutes. Ms. Perez stated that a staff sit inside the crib room when infants are napping.
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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: 07/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2021


LIC809 (FAS) - (06/04)
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