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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600967
Report Date: 03/22/2022
Date Signed: 03/22/2022 10:52:16 AM

Document Has Been Signed on 03/22/2022 10:52 AM - 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:CHILDREN'S CHOICE - INFANTFACILITY NUMBER:
376600967
ADMINISTRATOR:FREDA SIMMONSFACILITY TYPE:
830
ADDRESS:1465 EAST MADISON AVENUETELEPHONE:
(619) 442-4014
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY: 19TOTAL ENROLLED CHILDREN: 19CENSUS: 15DATE:
03/22/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:27 AM
MET WITH:Freda SimmonsTIME COMPLETED:
10:55 AM
NARRATIVE
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On 3/22/22 LPAs Annette Sutherland and Tyra Block conducted a case management visit to follow up on the self reporting incident that occurred on 1/24/22. Staff did not follow the child's need and services plan and offered the child water. Infant room census was 15 with 4 staff members. During our tour, LPAs observed appropriate ratios and capacity.

A type B deficiency is being cited on LIC 809D .

An exit interview was conducted with the Director. Notice of Site Visit (LIC 9213, Appeal Rights (LIC 9058) and a copy of the report (LIC809) was provided to Director .The Notice of Site Visit was posted during todays visits. Notice of site Visit must remain posted for 30 days.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2022
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 03/22/2022 10:52 AM - It Cannot Be Edited


Created By: Annette Sutherland On 03/22/2022 at 10:32 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: CHILDREN'S CHOICE - INFANT
FACILITY NUMBER: 376600967

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/22/2022
Section Cited
CCR
101427(c)

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Infant Care Food Services 101427(c) - The infant shall be fed in accordance with the individual plan. This requirement was not met as evidence by:
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The child is no longer enrolled. The director states going froward the needs and services plan will be followed.
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Based on record review and interviews, a 4 month old infant was offered water which was not included on the infants needs and services plan. This posses a potential health and safety risk for 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:Annette Sutherland
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2022


LIC809 (FAS) - (06/04)
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