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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701411
Report Date: 03/17/2025
Date Signed: 03/17/2025 10:24:13 AM

Document Has Been Signed on 03/17/2025 10:24 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: 20DATE:
03/17/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Elizabeth HannTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
NARRATIVE
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On 3/17/2025 at 9:10AM, Licensing Program Analysts Nancy Diaz and Jody Dye conducted an unannounced inspection. The purpose of this inspection is to follow-up on facility's self-reported incident that occurred on 3/13/2025. This incident involves an 18-month old child who was found to have a push pin in the mouth. A tour of the infant program was conducted with Ms. Hann. Observed present today were 20 infants with staff T. Nolin, T. Campbell Rice, M. Castillo-Madrid, A. Garcia, T. Arcieniega and M. Meza.
LPAs did not observed any choking hazards including push pins in the infant area today.

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

Exit interview was conducted with Elizabeth Hann, Site Director. LPAs reviewed and provided the site director a copy of licensing report. Appeal rights was also given. Notice of site visit and copy of this report must be posted for 30 days.

LPA Nancy Diaz informed facility representative, Elizabeth Hann that this report dated March 17, 2025 documents one Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.
Also, LPA Nancy Diaz informed the facility representative, Elizabeth Hann to provide a copy of this licensing report dated March 17, 2025 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

HSC Section 1596.8595© shall be cited for failure to provide copies to parents/guardians of children in care and newly enrolled children, and for failure to maintain written verification of receipt of, licensing reports indicating a Type A violation.
DEFICIENCY CITED ON LIC809D. CONTINUED...
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2025
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 03/17/2025 10:24 AM - It Cannot Be Edited


Created By: Nancy Diaz On 03/17/2025 at 09:42 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: 03/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/17/2025
Section Cited
CCR
101223(a)(1)

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PERSONAL RIGHTS.
To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.

This requirement was not met as evidenced by:
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Ms. Han stated that staff need to make sure that they check the infant areas, check their pockets to make sure that there are no choking hazzards in their person when they come in. Parents are no longer allowed in the infant area during drop-offs and pick-ups. Director will also have a log for staff who is checking the
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Based on documents received (unusual incident report) it was reported that an 18-month old child was found to have a thumb tack in the mouth during pick-up.
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areas to document that they are checking the areas for any choking hazzards. Director will require staff to check morning, mid-day and at the end of the day.

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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: 03/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/17/2025


LIC809 (FAS) - (06/04)
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