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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701411
Report Date: 09/06/2024
Date Signed: 09/06/2024 11:57:15 AM

Document Has Been Signed on 09/06/2024 11:57 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:COZY CUBSFACILITY NUMBER:
376701411
ADMINISTRATOR/
DIRECTOR:		ELIZABETH HANNFACILITY TYPE:
830
ADDRESS:2291 MAIN STREETTELEPHONE:
(760) 787-0612
CITY:RAMONASTATE: CAZIP CODE:
92065
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 15DATE:
09/06/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:01 AM
MET WITH:Elizabeth Hann & Annette KurtenbachTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
NARRATIVE
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On 9/6/24 @ 11:01AM, Licensing Program Analyst (LPA) Nancy Diaz conducted an unannounced case management inspection. Observed present in the infant room were 15 infants with 1 teacher and 3 aides.

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

Exit interview was conducted with Elizabeth Hann. LPA reviewed and provided a copy of the report with Elizabeth Hann. LPA also provided a copy of the appeal rights and notice of site visit that has to be posted for 30 days.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 09/06/2024 11:57 AM - It Cannot Be Edited


Created By: Nancy Diaz On 09/06/2024 at 10:34 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: COZY CUBS
FACILITY NUMBER: 376701411

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/06/2024
Section Cited
CCR
101416.5(b)(1)(A)

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STAFF-INFANT RATIO.
There shall be a ratio of one teacher for every four infants in attendance. There is a fully qualified teacher directly supervising no more than 12 infants.
This requirement was not met as evidenced by:
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Ms. Hann stated that a teacher went home ill. This was corrected when Ms. Annette stepped in to cover ratio in the infant room.
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Based on observation, The infant room was observed out of ratio with 15 infants: 1 teacher and 3 aides.
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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:Joelle Redding
LICENSING EVALUATOR NAME:Nancy Diaz
LICENSING EVALUATOR SIGNATURE:
DATE: 09/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2024


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