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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372000501
Report Date: 07/28/2023
Date Signed: 07/28/2023 02:55:36 PM


Document Has Been Signed on 07/28/2023 02:55 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:SAN CARLOS UNITED METHODIST WEEKDAY PRESCHOOLFACILITY NUMBER:
372000501
ADMINISTRATOR:WENDY KOZAFACILITY TYPE:
850
ADDRESS:6554 COWLES MOUNTAIN BOULEVARDTELEPHONE:
(619) 464-4335
CITY:SAN DIEGOSTATE: CAZIP CODE:
92119
CAPACITY:122CENSUS: 95DATE:
07/28/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Wendy KozaTIME COMPLETED:
03:00 PM
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On 7/28/2023, Licensing Program Analysts (LPAs) Patrick Ma and Martha Avila, made an unannounced Case Management inspection for a different purpose. During the visit, LPA’s learned children may be co-mingling with school-age children at the facility. LPA’s reviewed parent agreements and contracts and interviewed Director, Wendy Koza.

Due to insufficient information available at this time, the possible violation will need further investigation.

Exit interview conducted and report was reviewed with the facility representative Wendy Koza. A notice of site visit was given to Director and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.
SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Patrick MaTELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:
DATE: 07/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/28/2023
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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