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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845053
Report Date: 06/23/2022
Date Signed: 06/23/2022 08:34:55 AM

Document Has Been Signed on 06/23/2022 08:34 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:ALEXA'S PLAYCFACILITY NUMBER:
334845053
ADMINISTRATOR:FARA BOWLESFACILITY TYPE:
850
ADDRESS:25170 HANCOCK AVENUETELEPHONE:
(858) 966-8555
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 8DATE:
06/23/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH:Gabriela Padilla/Lead TeacherTIME COMPLETED:
08:40 AM
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A case management visit is being conducted by Licensing Program Analyst (LPA) James Wilkerson in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 05/31/22. It indicates that a child who is allergic to peanuts was provided a snack which included peanut flour, which was discovered after the fact. A parent was contacted and staff was instructed by the parent to monitor the child for any allergic reaction and to administer Benadryl per the instructions on the label. The child had no reaction and staff will have two members read the ingredients on labels from here on out to ensure that this doesn't happen in the future.

Lead Teacher, Gabriela Padilla was interviewed. Based on information gathered, the facility acted appropriately and no violations have been identified.

An exit interview was conducted, a Notice of Site Visit posted and a copy of this report was provided to the facility on this date.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: James Wilkerson
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2022
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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