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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372000227
Report Date: 08/19/2022
Date Signed: 08/19/2022 03:30:26 PM


Document Has Been Signed on 08/19/2022 03:30 PM - 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:GILLISPIE SCHOOLFACILITY NUMBER:
372000227
ADMINISTRATOR:MINDY COATES SMITHFACILITY TYPE:
850
ADDRESS:7380 GIRARD AVENUETELEPHONE:
(858) 459-3773
CITY:LA JOLLASTATE: CAZIP CODE:
92037
CAPACITY:140CENSUS: DATE:
08/19/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:TIME COMPLETED:
02:25 PM
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Licensing Program Analysts (LPAs) Jennifer Lott & Keturah Lane conducted an unannounced Case Management visit. LPAs were greeted at the front of the facility by Head of School, Allison Fleming and granted entry after identifying themselves and disclosing the purpose of their visit. Director, Mindy Coates-Smith arrived a short time later. The school was closed at the time of the inspection. There were no teachers or students present as school is scheduled to open on 08/30/22.

The visit was initiated due to a self-reported incident dated 06/01/22 and a 2nd incident dated 06/06/22. The licensee’s authorized representative, Director Coates-Smith self-reported this incident by submitting form LIC 624 – Unusual Incident/Injury Report to Community Care Licensing (CCL), which was received in our office on 06/07/22. .

During today’s visit, LPAs discussed the incidents with the director.

Based on today’s visit, no deficiencies were observed at this time. Exit interview conducted and report was reviewed with Director, Coates-Smith. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 629-8413
LICENSING EVALUATOR NAME: Jennifer LottTELEPHONE: 619-782-8300
LICENSING EVALUATOR SIGNATURE:
DATE: 08/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/19/2022
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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