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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370800120
Report Date: 08/16/2019
Date Signed: 08/16/2019 11:49:36 AM

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:CHRISTIAN CREATIVE LEARNING ACADEMYFACILITY NUMBER:
370800120
ADMINISTRATOR:JESSICA WHEELERFACILITY TYPE:
850
ADDRESS:2920 MAIN STTELEPHONE:
(619) 698-4306
CITY:LEMON GROVESTATE: CAZIP CODE:
91945
CAPACITY:70CENSUS: 15DATE:
08/16/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Jessica WheelerTIME COMPLETED:
11:50 AM
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Licensing Program Analyst (LPA) Jo Ann Legaspi conducted a case management inspection to follow-up on an incident that occurred on 08/08/2019. LPA advised Director Jessica Wheeler of the meeting’s purpose and was granted facility entry.

Director Wheeler accompanied LPA on a brief facility tour. LPA observed the children to be involved in indoor and outdoor activities. Appropriate ratios were maintained and visual observation noted.

It was reported that a child’s personal rights were possibly violated. The incident was self-reported by the facility and a written report was received in the Licensing office within the required reporting period. LPA conducted a brief facility tour, interviewed staff and children. LPA also reviewed facility records.

No deficiencies were observed.

Staff was provided with A Notice of Site Visit (LIC 9213), which is to be posted for thirty (30) days.

An exit interview was conducted with Director Wheeler. Licensee Rights (LIC 9098 01/16) along with a copy of this report was provided to Director Wheeler and their signature on this form confirms receipt of these rights.


SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2205
LICENSING EVALUATOR NAME: JoAnn R LegaspiTELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2019
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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