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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334843950
Report Date: 10/29/2019
Date Signed: 10/29/2019 01:08:40 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:WILD ROOTS HOLISTIC LEARNING CENTERFACILITY NUMBER:
334843950
ADMINISTRATOR:TANYA GAETEFACILITY TYPE:
830
ADDRESS:27655 JEFFERSON AVENUETELEPHONE:
(951) 676-8300
CITY:TEMECULASTATE: CAZIP CODE:
92590
CAPACITY:8CENSUS: 10DATE:
10/29/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Tanya GaeteTIME COMPLETED:
01:20 PM
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Licensing Program Analyst (LPA) James Wilkerson arrived at this facility per a request from the facility for a capacity increase. The facility was toured inside and out. The request is for an additional 12 infants. The capacity will be increased from 8 to 20 infants. A previous report dated 12/12/16 shows that room #2 can hold up to 16 preschool children. Room number two will be converted to an infant room, for the additional 12 infants. A fire clearance was granted on 10/21/19 with a maximum capacity of 12 infants for room #2 (Sage Room) and 8 infants in room #3 (Lavender Room). The Lavender room will be for ages 0-12 months of age and the Sage room will be for children ages 12-24 months.


An exit interview was conducted and a copy of this report was provided to Ms. Gaete on this date.

A copy of this report must be made available to the public, upon request for three years.
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: James WilkersonTELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019
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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