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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370806459
Report Date: 05/20/2026
Date Signed: 05/20/2026 04:05:20 PM

Document Has Been Signed on 05/20/2026 04:05 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: 191CENSUS: 0DATE:
05/20/2026
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:05 PM
MET WITH:Michell SyversonTIME VISIT/
INSPECTION COMPLETED:
04:05 PM
NARRATIVE
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On May 20, 2026, at 3:05 PM, an office meeting was held at the San Diego Child Care Regional Office to discuss the three separate incidents of lack of care of supervision within a twelve month period. In attendance were Licensee Representative Michelle Syverson, Licensing Program Manager (LPM) Tulam Vu, and Licensing Program Analysts (LPAs) Oscar Picazo and Vicky Williamson.

On April 22, 2025, the facility received a Type A deficiency under Section 101229(a)(1), Responsibility for Providing Care and Supervision. The citation stemmed from an incident on April 16, 2025, in which a three-year-old child in care was left unsupervised outside of the classroom for approximately less than one minute during the transition from inside the classroom to the playground.

On March 20, 2026, the facility received another Type A deficiency under Section 101229(a)(1), stemming from an incident on March 5, 2026. In this incident, a 3-year-old child in care walked out of the classroom and walked unsupervised toward the front of the facility. The child was unsupervised for approximately three minutes. Another repeat incident occurred on March 13, 2026 involving the same child.

The facility promptly corrected all deficiencies. The facility submitted plans of corrections to the Department which included staff retraining, a staff sign in sheet and a written plan detailing new transitioning and supervision procedures. The plans indicated that staff were retrained on transition procedures for indoor and outdoor, name-to-face protocols, active supervision, staff positioning, immediate reporting of incidents to licensee representative, the use of additional support staff, orientation for new staff, and quarterly in-service training for all staff. Doorbells have been installed in some classrooms and additional doorbells are on order for all classrooms.

NAME OF LICENSING PROGRAM MANAGER: Tulam Vu
NAME OF LICENSING PROGRAM ANALYST: Oscar Picazo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/20/2026
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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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: 05/20/2026
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A staff meeting was held to reinforce supervision requirements, and a training verification form signed by participating staff was provided.

During the office meeting, the Licensing Program Manager (LPM) and Licensing Program Analyst (LPA) reviewed the serious deficiencies with the Licensee Representative. The discussion emphasized the importance of proper supervision and compliance with Section 101229, Responsibility for Providing Care and Supervision to prevent future violations.

Technical Support Program (TSP) services and training opportunities were reviewed with the Licensing Representative, and they were advised to register for Provider Information Notifications (PINs). Licensee Representative were advised that repeated violations or failure to comply with licensing laws and regulations may result in administrative action taken by the Department. The Licensee Representative acknowledged the seriousness of the matter and affirmed their commitment to ensuring the facility remains in full compliance with all applicable laws and regulations.

LPM and LPAs discussed and provided the Licensing Representative with the following resources: Best Practices Lack of Supervision handout, A Technical Support Program (TSP) brochure.mailto:childcaretechnicalsupport@dss.ca.gov, Advocate information was provided: (714) 703-2800 or childcareadvocatesprogram@dss.ca.gov, https://www.smarthorizons.org/childcare and R&R (YMCA) https://www.ymcasd.org.

Please submit any Unusual Incident Reports by email to: SDIncidentReports@dss.ca.gov and the Duty Line 619-767-2248.

Licensee Representative stated that they are interested in participating in the TSP program.

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

DATE: 05/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2026
LIC809 (FAS) - (06/04)
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