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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105075
Report Date: 09/14/2022
Date Signed: 09/14/2022 04:09:40 PM

Document Has Been Signed on 09/14/2022 04:09 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:
376105075
ADMINISTRATOR:AIMEE AINSWORTHFACILITY TYPE:
830
ADDRESS:7150 RANCHO SANTA FE ROADTELEPHONE:
(760) 891-0902
CITY:CARLSBADSTATE: CAZIP CODE:
92009
CAPACITY: 24TOTAL ENROLLED CHILDREN: 18CENSUS: 18DATE:
09/14/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Felicia TriplettTIME COMPLETED:
04:20 PM
NARRATIVE
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On 9/14/22 at 1:00PM, an unannounced case management inspection made by Licensing Program Analysts (LPAs) Saraliz Velando and Selina Siao to follow up on an incident report that occurred on 8/31/22 at approximately 11:00AM. Upon arrival, LPAs met with director, Felicia Triplett. The following ratios were observed in the Toddler Room. They had 12 children being supervised by Elizabeth Angeles and Emily Savitski. In the Infant room, there was 6 infants supervised by Destiny Patricio and Liudan Lu. Staff members have the required background clearances and are associated to the facility.

The facility self-reported the incident to the department by fax on 9/1/22 and was reported in a timely manner. During the incident on 8/31/22, the staff ratio was 9 children to 3 staff members. The incident was regarding an infant that remained on the playground while the rest of his class had transitioned back into the classroom. The child was brought back to his classroom by a preschool teacher.

Staff members involved were interviewed and based on the information, it appears that the face-to-name procedure was not followed properly and the child was left behind for approximately 50 seconds.

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

Exit interview conducted and report was reviewed with the director, Felicia Triplett.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Saraliz Velando
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2022
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 2
Document Has Been Signed on 09/14/2022 04:09 PM - It Cannot Be Edited


Created By: Saraliz Velando On 09/14/2022 at 03:36 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: EVERBROOK ACADEMY DBA PRESTIGE PRESCHOOL ACADEMY
FACILITY NUMBER: 376105075

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/14/2022
Section Cited
CCR
101429(a)(1)

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Responsibility for Providing Care and Supervision for Infants
In addition to Section 101229, the following shall apply: (1) Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times. This requirement was not met as evidenced by:
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Director stated that the playground safety procedures were reviewed again on the same day with the involved staff. Face to name procedure was reviewed. Director will provide training with staff members and she will submit the training agenda along with the staff members sign in sheet to Licensing no later than 9/19/22.
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On 8/31/22, an infant was left behind at the playground area for approximately fifty seconds, while the rest of his class was back to the classroom. This poses a potential health and safety risk to children in care.
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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: 09/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2022


LIC809 (FAS) - (06/04)
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