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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105074
Report Date: 09/29/2022
Date Signed: 09/29/2022 01:16:57 PM

Document Has Been Signed on 09/29/2022 01:16 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:EVERBROOK ACADEMY DBA PRESTIGE PRESCHOOL ACADEMYFACILITY NUMBER:
376105074
ADMINISTRATOR:AIMEE AINSWORTHFACILITY TYPE:
850
ADDRESS:7150 RANCHO SANTA FE ROADTELEPHONE:
(760) 891-0902
CITY:CARLSBADSTATE: CAZIP CODE:
92009
CAPACITY: 146TOTAL ENROLLED CHILDREN: 146CENSUS: 48DATE:
09/29/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:36 AM
MET WITH:Tammi Reliford, District ManagerTIME COMPLETED:
01:20 PM
NARRATIVE
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On 9/29/22 at 10:36AM, an unannounced case management inspection made by Licensing Program Analysts (LPAs) Saraliz Velando and Nancy Diaz to follow up on an incident report that occurred on 9/13/22 and 9/16/22 at approximately 11:00AM. Upon arrival, LPAs met with District Manager, Tammi Reliford. A tour of the facility was conducted and LPAs observed 48 children in care.

The facility self-reported the incidents to the department by fax on 9/20/22. During the incident of 9/13/22 a child was found outside his classroom door by a staff member and brought back to his classroom. According to staff, the child was missing for approximately 3 minutes. During the incident on 9/16/22, same child was found in preschool classroom 2, with the door closed and by himself. According to staff, the child was missing for approximately 5 minutes.

Staff member involved was interviewed and based on the information, it appears that the Face-to-Name procedure was not followed properly during both incidents resulting in failure to visually supervise.

Type B Violation was cited.
Civil penalty is being assessed at this time for Repeat Violation.

Refer to the next page LIC 809D for deficiency citation. Facility was provided a copy of the appeal rights.

Exit interview was conducted and report was reviewed with the district manager, Tammi Reliford.

A notice of site visit was given and observed posted, this notice shall remain posted for 30 days.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Saraliz Velando
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2022
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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Document Has Been Signed on 09/29/2022 01:16 PM - It Cannot Be Edited


Created By: Saraliz Velando On 09/29/2022 at 11:36 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: EVERBROOK ACADEMY DBA PRESTIGE PRESCHOOL ACADEMY
FACILITY NUMBER: 376105074

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/06/2022
Section Cited
CCR
101229(a)(1)

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RESPONSIBILITY FOR PROVIDING CARE AND SUPERVISION
(1) No child(ren) shall be left without the supervision... Supervision shall include visual observation.
This requirement was not met as evidenced by:

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District manager stated that staff members will continue to actively monitor and make changes needed in real time during procedures. A written plan of correction is due to the department by 10/6/22.
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Based on staff interview and document received the facility failed to provide visual supervision resulting to a child leaving the classroom.
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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:Monica Cuddy
LICENSING EVALUATOR NAME:Saraliz Velando
LICENSING EVALUATOR SIGNATURE:
DATE: 09/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2022


LIC809 (FAS) - (06/04)
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