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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105075
Report Date: 09/29/2022
Date Signed: 09/29/2022 12:51:13 PM

Document Has Been Signed on 09/29/2022 12:51 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
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: 24CENSUS: 17DATE:
09/29/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:District Manager, Tammi RelifordTIME COMPLETED:
10:35 AM
NARRATIVE
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On 9/29/22 at 9:10AM, an unannounced case management inspection was made by Licensing Program Analysts (LPAs) Saraliz Velando and Nancy Diaz. The purpose of this inspection is to follow up on the correction to a deficiency cited on 9/14/22. LPAs met with Tammi Reliford, District Manager. There were 17 infants present.

Facility submitted correction on 9/29/22 via email from Tammi Reliford. Facility failed to submit correction in a timely manner.

Civil penalty is being assessed.

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 Tammi Reliford.

A notice of site visit was given and observed posted and 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 12:51 PM - It Cannot Be Edited


Created By: Saraliz Velando On 09/29/2022 at 10:46 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: 376105075

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/29/2022
Section Cited
CCR
101995

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PENALTIES
(f) If any deficiency is not corrected by the date specified ...following that date until compliance has been demonstrated.
This regulation was not met as evidenced by:
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LPAs met with Tammi Reliford, proof of correction was received on 9/29/22.
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Based on documentation received on 9/29/22, the facility failed to submit correction in a timely manner.
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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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