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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701251
Report Date: 01/19/2022
Date Signed: 09/21/2022 01:21:37 PM

Document Has Been Signed on 09/21/2022 01:21 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:ASPEN LEAF NURSERYFACILITY NUMBER:
376701251
ADMINISTRATOR:NANETTE ARNOLDFACILITY TYPE:
830
ADDRESS:3111 30TH STREETTELEPHONE:
(619) 285-0767
CITY:SAN DIEGOSTATE: CAZIP CODE:
92104
CAPACITY: 6TOTAL ENROLLED CHILDREN: 7CENSUS: 5DATE:
01/19/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Nanette ArnoldTIME COMPLETED:
01:00 PM
NARRATIVE
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On 01/19/2022 at 9:15am, Licensing Program Analysts (LPAs) Martha Malane and Cindy Meier conducted an unannounced Case Management Inspection at the facility for the purpose of reviewing the operation of the facility. LPAs met with Director, Nanette Arnold. There were five (5) infant children with two (2) staff.

No deficiencies cited.

See LIC809-C for continuation...

This is an amended version of an original report created on 01/19/2022

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Martha Malane
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2022
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: ASPEN LEAF NURSERY
FACILITY NUMBER: 376701251
VISIT DATE: 01/19/2022
NARRATIVE
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Appeal Rights were discussed and provided. The signature at the bottom of this report confirms receipt. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the facility representative, Nanette Arnold.

This is an amended version of an original report created on 01/19/2022.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Martha Malane
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 07/27/2022 03:06 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 07/27/2022 11:43 AM


Created By: Martha Malane On 01/19/2022 at 10:53 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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: ASPEN LEAF NURSERY
FACILITY NUMBER: 376701251

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
01/19/2022
Section Cited
CCR
101223(a)(2)

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Personal Rights
101223 (a)(2) The facility administrator shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
This requirement was not met as evidenced by:
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Facility representative stated she will submit to CCL the plan of correction which will be implemented within 24 hours of the date and time of thiis report.
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Based on LPA observations and interviews conducted, the facility administrator did not ensure the personal rights of children in care with safe and healthful accommodations as two (2) staff were not wearing face coverings indoors as required by the State Public Health Officer Order dated June 11, 2021, which poses a potential risk to the health, safety, or personal rights of 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:Tulam Vu
LICENSING EVALUATOR NAME:Martha Malane
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2022


LIC809 (FAS) - (06/04)
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