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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
304370847
Report Date:
11/20/2019
Date Signed:
11/20/2019 04:10:35 PM
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
750 THE CITY DRIVE, SUITE 250
ORANGE
,
CA
92868
FACILITY NAME:
NOBIS PRESCHOOL
FACILITY NUMBER:
304370847
ADMINISTRATOR:
NEITZKE, ASHLEY
FACILITY TYPE:
830
ADDRESS:
26153 VICTORIA BLVD.
TELEPHONE:
(949) 661-6258
CITY:
CAPISTRANO BEACH
STATE:
CA
ZIP CODE:
92624
CAPACITY:
16
CENSUS:
7
DATE:
11/20/2019
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
03:35 PM
MET WITH:
Pari Rad
TIME COMPLETED:
04:20 PM
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A case management inspection was made this date by Licensing Program Analyst (LPA) Connolly to deliver an amended report dated 7/24/2019. The amended report notes an 'A' violation was amended to a 'B' violation.
Present this date was licensee Pari Rad who accompanied the LPA on a tour of the infant center. Census was taken. There were seven infants in care with two attending staff. All infants were awake engaged in the activities of the day care.
A review of criminal clearance records on this date indicates adults who require caregiver background checks have received criminal record and child abuse index clearances.
Licensee signed the amended report. Amended report was left at the facility. No deficiencies were observed.
Exit interview was conducted. Notice of Site Visit was posted.
SUPERVISOR'S NAME:
Rina Lopez
TELEPHONE:
(714) 703-2808
LICENSING EVALUATOR NAME:
Gesine Connolly
TELEPHONE:
(714) 293-9314
LICENSING EVALUATOR SIGNATURE:
DATE:
11/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/20/2019
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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