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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 136608107
Report Date: 06/26/2019
Date Signed: 06/26/2019 06:01:45 PM

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:EL CENTRO EARLY LEARNING CENTERFACILITY NUMBER:
136608107
ADMINISTRATOR:MARRIETTA GILLIARDFACILITY TYPE:
850
ADDRESS:1950 IMPERIAL AVENUETELEPHONE:
(619) 228-2054
CITY:EL CENTROSTATE: CAZIP CODE:
92243
CAPACITY:472CENSUS: 0DATE:
06/26/2019
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
04:50 PM
MET WITH:Doreen Mulz & Wendy MarquezTIME COMPLETED:
06:10 PM
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Licensing Program Analyst (LPA) Yolanda Baez met with Doreen Mulz & Director/ new Applicant Wendy Marquez at the San Diego Child Care Regional Office to comply with Component II orientation requirements.

The following application documents were corrected during this visit which included: Correcting the LIC 200A (application) to correct the days and hours of operation and the LIC 309 was corrected to place the corporation number as well as facility number. LPA received LIC 508, LIC 9182, LIC 9108, and copy of 8 hr preventative health course for Wendy Marquez. The following documents are pending correction and will be obtained at the pre-licensing inspection: Sample menu (need to add portions), please add a second temporary relocation site to the LIC 610 (must be about 2 miles away AND please include a phone number), On page 4 under "Our Program" section please make the changes to the ages that you serves. Please also make the discussed changes to your Incidental Medical Services (IMS) Plan of Operation.



For Wendy Marquez:
  • Please provide an LIC 503 that verifies health and TB test requirement
  • Please provide a copy of immunization records to show immunity against Pertussis, Measles, and Influenza to show compliance for SB792. If you decide to opt out of the Influenza vaccine, please provide a declaration that is signed and dated
  • Please provide proof of completion of the mandated reporter training to show compliance with AB1207. The training may be located at www.mandatedreporterca.com
  • LIC 501: Personnel Record
  • CPR/FA certificate
  • Component I (Application) & Component III (Record Keeping) orientation certificates
  • Copy of transcripts OR Site Supervisor Permit
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Yolanda BaezTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019
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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