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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701491
Report Date: 07/25/2022
Date Signed: 07/25/2022 04:32:36 PM

Document Has Been Signed on 07/25/2022 04:32 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:ACADEMY OF PLAY LLCFACILITY NUMBER:
376701491
ADMINISTRATOR:CINTHYA BAEZFACILITY TYPE:
850
ADDRESS:7255 UNIVERSITY AVENUETELEPHONE:
(619) 631-7284
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY: 19TOTAL ENROLLED CHILDREN: 19CENSUS: 4DATE:
07/25/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:19 PM
MET WITH:Cinthya Baez, Facility DirectorTIME COMPLETED:
04:32 PM
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On July 25, 2022 at 3:19 PM, Licensing Program Analyst (LPA), Marie Hernandez conducted an unannounced Case Management Inspection due to an incident with child #1. On 05/11/2022, the Department received the incident report from the facility for child #1. LPA met with the facility director, Cinthya Baez. Through the course of the incident review, LPA interviewed the staff person but could not interview child #1 because he is nonverbal.
The facility reported that on 05/11/2022 at approximately 10:40, AM, that child #1 tripped and fell during outside play time (play yard). The child fell and sustained a red bump on his forehead. The staff person immediately tended to child’s needs and placed a cold compression on child’s forehead. The parent was contacted but did not take child to the doctors. The staff person observed the incident with child #1. LPA inspected the play yard for safety hazards and did not observe any at time of visit. The staff was proactive by tending to child’s needs. The incident was an accident. This concludes the incident review.

An exit interview was conducted and the report was provided to the facility director, Cinthya Baez. The Notice of Site Visit was provided and posted by the Facility Director.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Marie Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2022
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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