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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701499
Report Date: 10/28/2022
Date Signed: 11/14/2022 11:24:17 AM

Document Has Been Signed on 11/14/2022 11:24 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 ACADEMY, INC - INFANTFACILITY NUMBER:
376701499
ADMINISTRATOR:JENNIFER GRAWVUNDERFACILITY TYPE:
830
ADDRESS:73 NORTH SECOND AVENUETELEPHONE:
(619) 425-9933
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 10DATE:
10/28/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Brenda CasillasTIME COMPLETED:
03:50 PM
NARRATIVE
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On 10/28/22 at 3:00pm, LPA Adrian Castellon conducted an unannounced complaint inspection. LPAs met with director Brenda Casillas.

During the complaint inspection, a licensing violation was noticed. 5 Infants that are unable to climb out of a crib or playpen were found to be sleeping on mats on the floor. This LIC809 and LIC809D will be used to document the citation.

See LIC809D for Type B deficiency cited.

Exit interview conducted. Appeal rights were discussed and given to director on this date. Notice of Site Visit was given to director .
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Adrian Castellon
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2022
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 11/14/2022 11:24 AM - It Cannot Be Edited


Created By: Adrian Castellon On 10/28/2022 at 02:47 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: CHILDREN'S CHOICE ACADEMY, INC - INFANT
FACILITY NUMBER: 376701499

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/04/2022
Section Cited
CCR
101439.1(b)

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101439.1(b) Infant Care Center Sleeping Equipment: A crib or portable-crib meeting United States Consumer Product Safety Commission safety standards shall be provided for each infant who is unable to climb out of a crib.
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Licensee will have a crib or portable crib for each infant in care that is not able to climb out of the crib or portable crib. If the infant cannot climb out ny themselves, they must sleep in a crib or portable crib.
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This requirement was not met as evidenced by: 5 Infants that are unable to climb out of a crib or playpen were found to be sleeping on mats on the floor This could pose a threat to the health
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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:Cynthia Gray
LICENSING EVALUATOR NAME:Adrian Castellon
LICENSING EVALUATOR SIGNATURE:
DATE: 10/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2022


LIC809 (FAS) - (06/04)
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