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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370806459
Report Date: 03/19/2026
Date Signed: 03/20/2026 03:51:08 PM

Document Has Been Signed on 03/20/2026 03:51 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
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:V.I.P. VILLAGE - STATE PRESCHOOLFACILITY NUMBER:
370806459
ADMINISTRATOR/
DIRECTOR:		MICHELLE SYVERSONFACILITY TYPE:
850
ADDRESS:1001 FERN AVENUETELEPHONE:
(619) 628-8690
CITY:IMPERIAL BEACHSTATE: CAZIP CODE:
91932
CAPACITY: 191TOTAL ENROLLED CHILDREN: 208CENSUS: 114DATE:
03/19/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Michelle SyversonTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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On March 20, 2026, at 8:40 AM, Licensing Program Analysts (LPAs), Oscar Picazo and Vicky Williamson conducted an unannounced Case Management inspection to follow up on 2 self reported incidents. LPAs met with Facility Representative Michelle Syverson. LPAs discussed the purpose of the inspection and toured both the indoor and outdoor areas of the facility. There were 114 children present with 25 staff members.

On March 10, 2026, the Facility Representative reported an incident regarding an absence of supervision of Child #1 (C1). Per the Facility Representative, the incident occurred on March 5, 2026, at about 3:10 PM outside of classroom 2 during the dismissal of children. Facility Representative stated that there were 16 children present with one (1) Teacher and one (1) Instructional Assistant.

Interviews were conducted with the facility representative and staff members. LPA’s obtained a copy of the facility roster, personnel report, sign in/ sign out sheets, and requested a copy of the video footage. Staff and C1’s records were reviewed. LPAs inspected the inside and outside of classroom 2 and the area where C1 was located. LPAs also reviewed video footage of the incident during the time of inspection.

S1 stated that on March 5, 2026, there were 16 children present inside of the classroom with one (1) Instructional Assistant. S1 stated that at approximately 3:10 PM while assisting parents with signing their children out of the facility, C1 walked out of classroom 2. S1 stated they did not observe C1 walk out of the classroom however, at approximately 3:11 PM, S1 realized that C1 was not in the classroom. S1 stated they did not observe C1 leaving the classroom however, at approximately 3:11 PM, S1 realized that C1 was not in the classroom. S1 stated they immediately exited the classroom and observed C1 walking near the multi-Purpose Room. S1 stated that they immediately ran after C1.

See LIC 809C Continuation...

NAME OF LICENSING PROGRAM MANAGER: Tulam Vu
NAME OF LICENSING PROGRAM ANALYST: Oscar Picazo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: V.I.P. VILLAGE - STATE PRESCHOOL
FACILITY NUMBER: 370806459
VISIT DATE: 03/19/2026
NARRATIVE
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S1 stated that upon reaching C1 near the main office, C1 had already made contact with their authorized representative who had arrived at the facility. S1 stated that they all returned to the classroom together and signed out C1. S1 stated that C1 was without supervision for approximately 1 minute.

Facility Representative stated that a review of video footage for March 5, 2026 at 3:10 PM, revealed C1 walking out of classroom 2 to the front of the facility. Facility Representative stated that C1 was also observed on video footage at 3:12 PM meeting up with their authorized representative near the main office. Facility Representative stated that they were notified of the incident on March 6, 2026.

On March 13, 2026, the Facility Representative reported an incident regarding an absence of supervision involving C1. Per the Facility Representative, the incident occurred on March 13, 2026, at about 3:10 PM outside of classroom 2 during the dismissal of children. This is the second occurrence of an absence of supervision at the facility involving S1 and C1. During this incident C1 was located in front of classroom 4 by their authorized representative. Facility Representative stated that there were 8 children present with one Teacher and one Instructional Assistant.

S1 stated that on March 13, 2026, there were 7 children present inside of the classroom with one Teacher and one Instructional Assistant . S1 stated that at approximately 3:10 PM while assisting parents with signing their children out of the facility, C1 walked out of classroom 2. The interview was ended and additional information was not available.

Facility Representative stated that a staff meeting was held on March 11, 2026, to discuss safety and security, transition logs, name-to-face procedures, supervision in childcare centers licensing video, and arrival/dismissal procedures. Facility Representative stated that they have placed a door blocker to prevent children from leaving the class without supervision.

LPAs review of video footage provided evidence that C1 was left without supervision outside of the classroom for approximately 3 minutes on March 5, 2026 and then again on March 13, 2026 C1 was left without supervision outside of the classroom for approximately 1 minute.

Based on interview statements and LPAs review of video footage it has been determined that C1 was left without supervision outside of classroom 2 on March 5, 2026 and March 13, 2026.

See LIC 809C Continuation...

NAME OF LICENSING PROGRAM MANAGER: Tulam Vu
NAME OF LICENSING PROGRAM ANALYST: Oscar Picazo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2026
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: V.I.P. VILLAGE - STATE PRESCHOOL
FACILITY NUMBER: 370806459
VISIT DATE: 03/19/2026
NARRATIVE
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California Code of Regulations, (Title 22, Division 12 & Chapter 1), are being cited on the attached LIC 809D.

LPAs Oscar Picazo and Vicky Williamson informed facility representative Michelle Syverson that this report dated March 20, 2026, documents one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPAs Oscar Picazo and Vicky Williamson informed the facility representative Michelle Syverson to provide a copy of this licensing report dated March 20, 2026 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.

LPAs discussed with Facility Representative, Title 22 Regulation section 101212 Reporting Requirements. Facility Representative was provided with the Child Care Licensing Duty Line at (619) 767-2248. Submit Unusual Incident reports to SDIncidentReports@dss.ca.gov or by Fax at (619) 767-2203 to submit Unusual Incident Reports.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative Michelle Syverson.

NAME OF LICENSING PROGRAM MANAGER: Tulam Vu
NAME OF LICENSING PROGRAM ANALYST: Oscar Picazo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/20/2026 03:51 PM - It Cannot Be Edited


Created By: Oscar Picazo On 03/19/2026 at 09:00 PM
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: V.I.P. VILLAGE - STATE PRESCHOOL
FACILITY NUMBER: 370806459

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/19/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/20/2026
Section Cited
CCR
101229(a)(1)

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The licensee shall provide care and supervision... No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation.
This requirement is not met as evidence by:
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Facility Representative stated that she conducted a training on March 11, 2026 regarding supervision and transition procedures of children. Facility provided LPAs with a training agenda. Facility Representative will submit a staff sign in sheet and a written plan detailing new
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Based on interview and record review, the licensee did not comply with the section cited above in that it was determined that on 3/5/26 and 3/13/26, there was an absence of supervision resulting in C1 being left unsupervised which poses an immediate, safety, or personal rights risk to persons in care.
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 transitioning and supervision procedures and provide to the San Diego Regional Office by March 23, 2026.

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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.
Tulam Vu
NAME OF LICENSING PROGRAM MANAGER:
Oscar Picazo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/20/2026


LIC809 (FAS) - (06/04)
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